Comparison of the Application Effects of bilateral decompressive Craniectomy and unilateral large Craniectomy in the Treatment of Patients with contrecoup severe Brain Injury
Objective To explore the difference in the application effect of bilateral decompressive craniectomy and unilateral large craniectomy in the treatment of patients with contrecoup severe brain injury.Methods A total of 82 patients with contrecoup severe brain injury treated at Changzheng People's Hospital in Shangqiu City from August 2017 to October 2020 were selected as the study subjects.They were randomly divided into bilateral group and unilateral group,with 41 cases in each group.Patients in the bilateral group received bilateral decompressive craniectomy,while patients in the unilateral group received unilateral large craniectomy.The perioperative intervention plan is the same for both groups of patients.The intracranial pressure status,Glasgow Coma Scale(GCS)score,and brain oxygen metabolism related indicators[cerebral jugular venous oxygen content(CjvO2)and difference of arterio-jugular venous oxygen content(Da-jvO2)]of two groups of patients were compared before and 7 days after surgery,and the treatment effect of the two groups of patients was compared.The surgical complications(cerebrospinal fluid leakage,intracranial infection,traumatic epilepsy,and intracranial rebleeding)of the two groups of patients were compared.Results Before surgery,there was no statistically significant difference in intracranial pressure,GCS score,CjvO2,and Da-jvO2 between the two groups of patients(P＞0.05).At 7 days after surgery,the intracranial pressure and Da-jvO2 of both groups of patients were lower than those before surgery,while the GCS score and CjvO2 were higher than those before surgery,and the differences were statistically significant(P＜0.05).At 7 days after surgery,the intracranial pressure and Da-jvO2 of patients in the bilateral group were lower than those in the unilateral group,and the GCS score and CjvO2 of patients in the bilateral group were higher than those in the unilateral group,with statistical significance(P＜0.05).The treatment effect of patients in the bilateral group was better than that of patients in the unilateral group,and the difference was statistically significant(P＜0.05).The incidence of complications in bilateral group patients[7.32%(3/41)]was significantly lower than that in unilateral group patients[34.15%(14/41)],and the difference was statistically significant(P＜0.05).Conclusion Compared with unilateral decompressive craniectomy,bilateral decompressive craniectomy has a better clinical effect in the treatment of patients with contrecoup severe brain injury.It can effectively reduce postoperative intracranial pressure,improve GCS score and brain oxygen metabolism,and has fewer postoperative complications,making it worthy of clinical application.
contrecoup severe brain injurybilateral decompressive craniectomyunilateral large craniectomyintracranial pressure
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