摘要
目的 探讨着力部位硬膜外血肿(EH)、硬膜下血肿(SDH)单侧清除术联合去骨瓣减压术(DC)对重型颅脑损伤(sTBI)患者颅内血流动力学及短期预后的影响。方法 选取2018年6月—2022年10月收治的201例sTBI作为研究对象,按照治疗方式的不同分为观察组(予着力部位EH、SDH单侧清除术联合DC治疗)107例和对照组(予单侧颞额部血肿清除术联合DC治疗)94例。比较2组术后临床疗效,手术前后颅内血流动力学指标[大脑中动脉收缩期峰值流速(Vs)、平均血流速度(Vm)和搏动指标(PI)],手术前后视神经鞘直径(ONSD)、格拉斯哥昏迷量表(GCS)评分,以及短期预后和术后并发症发生率。结果 观察组术后总有效率(95.33%,102/107)高于对照组(85.11%,80/94)(P<0.05)。术后2组Vs、Vm均升高,PI均降低;术后观察组Vs、Vm高于对照组,PI低于对照组(P<0.01)。术后2组ONSD均较术前缩短,且观察组短于对照组(P<0.01);术后2组GCS评分均较术前升高,且观察组高于对照组(P<0.01)。观察组术后1个月预后良好率高于对照组,术后并发症总发生率低于对照组(P<0.01)。结论 着力部位EH、SDH单侧清除术联合DC治疗能改善sTBI患者颅内血流动力学指标和短期预后,降低术后并发症发生率。
Objective To investigate the effects of unilateral removal of epidural hematoma(EH)and subdural hematoma(SDH)in the focus area combined with decompressive craniotomy(DC)on intracranial hemodynamics and short-term prognosis in patients with severe traumatic brain injury(sTBI).Methods In total,201 patients with sTBI treated from June 2018 to October 2022 were selected as the research subjects,and were divided into observation group(unilateral removal of EH and SDH in the focus area combined with DC treatment,n=107)and control group(unilateral temporal frontal hematoma removal combined with DC treatment,n=94)according to different treatment methods.The postoperative clinical efficacy,intracranial hemodynamic indexes[middle cerebral artery peak systolic flow velocity(Vs),mean blood flow velocity(Vm),and pulse index(PI)],Glasgow coma score(GCS),optic nerve sheath diameter(ONSD),short-term prognosis and postoperative complication rate were compared between the two groups.Results The total effective rate of the observation group(95.33%,102/107)was higher than that of the control group(85.11%,80/94)(P<0.05).After operation,Vs and Vm were increased and PI was decreased in both groups(P<0.05).The levels of Vs and Vm in the observation group were higher than those in the control group,while PI was lower than that in the control group(P<0.01).After operation,ONSD was shortened in both groups,which was shorter er in the observation group than in the control group(P<0.01).After operation,GCS scores in both groups were higher than those before operation,which were higher in the observation group than in the control group(P<0.01).The excellent and good rate of prognosis in the observation group was higher than that in the control group at 1 month after operation,and the total incidence of postoperative complications was lower than that of the control group(P<0.01).Conclusion Unilateral removal of EH and SDH in the focus area combined with DC can improve intracranial hemodynamic indexes and short-term prognosis of sTBI patients,and reduce the incidence of postoperative complications.
作者
牛志成
袁静
张岚琦
刘俊
张煜
NIU Zhicheng;YUAN Jing;ZHANG Lanqi;LIU Jun;ZHANG Yu(Department of Critical Medicine,the First People's Hospital of Wuhu City,Wuhu,Anhui 241000,China;Department of Neurosurgery,the First People's Hospital of Wuhu City,Wuhu,Anhui 241000,China)
出处
《临床误诊误治》
CAS
2023年第8期67-71,共5页
Clinical Misdiagnosis & Mistherapy
基金
安徽省卫生健康委科研重点项目(AHWJ2021a038)。
关键词
颅脑损伤
血肿清除术
去骨瓣减压术
搏动指数
格拉斯哥昏迷量表
视神经鞘直径
预后
手术后并发症
Traumatic brain injury
Hematoma removal
Decompressive craniectomy
Pulsation index
Glasgow coma score
Optic nerve sheath diameter
Prognosis
Postoperative complication
