摘要
目的分析改良Paine点穿刺协助去骨瓣减压术治疗重型创伤性脑损伤的效果。方法选取2021年9月至2024年9月开封市中心医院收治的90例重型创伤性脑损伤患者作为研究对象,采用随机数表法分为观察组(45例)与对照组(45例),观察组患者行改良Paine点穿刺协助去骨瓣减压术治疗,对照组患者行Kocher点穿刺协助去骨瓣减压术治疗,对比观察两组患者治疗情况、颅内压水平、并发症发生及预后情况。结果观察组患者手术时间与对照组无明显差异(t=0.431,P=0.668),而颅内压监测持续时间、术后脱水剂使用时间均短于对照组(t=3.292、2.111,P=0.001、0.038),术后脱水剂使用剂量少于对照组(t=2.363,P=0.020);治疗1、3 d,观察组患者颅内压水平均低于对照组(t=4.172、4.505,P均<0.001);观察组患者术后再出血、颅内感染发生率低于对照组(χ^(2)=5.075、4.444,P=0.024、0.035),而间质性脑水肿、脑穿通畸形发生率与对照组无明显差异(χ^(2)=0.345、1.011,P=0.557、0.315);术后6个月,观察组患者预后情况优于对照组(Z=-2.036,P=0.042)。结论与Kocher点穿刺协助去骨瓣减压术相比,改良Paine点穿刺协助去骨瓣减压术治疗重型创伤性脑损伤的引流效果更好,更能有效控制患者颅内压水平,降低并发症发生风险,改善预后。
Objective To analyze the clinical efficacy of modified Paine point puncture-assisted decompressive craniectomy in the treatment of severe traumatic brain injury.Methods 90 patients with severe traumatic brain injury admitted to Kaifeng Central Hospital from September 2021 to September 2024 were enrolled as research subjects,and divided,using the random number table,into the observation group(n=45)and the control group(n=45).Patients in the observation group received modified Paine point puncture-assisted decompressive craniectomy,while those in the control group received Kocher point puncture-assisted decompressive craniectomy.Treatment conditions,intracranial pressure levels,complication occurrence,and prognosis were compared between the two groups.Results There was no significant difference in operative time between the two groups(t=0.431,P=0.668).The duration of intracranial pressure monitoring and postoperative dehydrating agent use were both shorter in the observation group than the control group(t=3.292 and 2.111,P=0.001 and 0.038),while the total dosage of postoperative dehydrating agent was significantly lower(t=2.363,P=0.020).On postoperative days 1 and 3,the mean intracranial pressure levels in the observation group were significantly lower than those in the control group(t=4.172 and 4.505,both P<0.001).The incidences of postoperative rebleeding and intracranial infection were lower in the observation group(χ^(2)=5.075 and 4.444,P=0.024 and 0.035),while there were no significant differences in the incidences of interstitial cerebral edema and porencephalic malformations between the two groups(χ^(2)=0.345 and 1.011,P=0.557 and 0.315).At six months postoperatively,the prognosis of patients in the observation group was significantly better than that in the control group(Z=-2.036,P=0.042).Conclusion Compared with Kocher point puncture-assisted decompressive craniectomy,modified Paine point puncture-assisted decompressive craniectomy has a better drainage effect in the treatment of severe traumatic brain injury,and can effectively control the patient's intracranial pressure level,reduce the risk of complications,and improve the prognosis.
作者
徐霞辉
张海军
曹培超
薛长理
梁春东
XU Xiahui;ZHANG Haijun;CAO Peichao;XUE Changli;LIANG Chundong(Department of Neurosurgery,Kaifeng Central Hospital,Kaifeng,Henan 475000,China)
出处
《中国烧伤创疡杂志》
2025年第6期446-449,共4页
The Chinese Journal of Burns Wounds & Surface Ulcers
