摘要
目的 探讨预见性双侧平衡去骨瓣减压术治疗重型颅脑损伤的临床疗效.方法 回顾性分析2019年1月至2023年1月收治的78例重型颅脑损伤的病历资料.采用预见性双侧平衡去骨瓣减压术治疗40例(观察组),采用分次双侧去骨瓣减压术治疗38例(对照组).比较术后3个月病死率、并发症(包括颅内再出血、脑膨出、脑积水、颅内感染)发生率;术后3个月根据日常生活能力(ADL)分级评估预后,其中Ⅰ～Ⅲ级为预后良好,Ⅳ～Ⅴ级为预后不良.结果 观察组术后3个月病死率(10.0％,4/40)明显低于对照组(28.9％,11/38;P=0.034).观察组术后并发症发生率(22.5％,9/40)明显低于对照组(44.7％,17/38;P=0.037).观察组术后3个月ADL分级Ⅰ级7例,Ⅱ级9例,Ⅲ级7例,Ⅳ级8例,Ⅴ级5例;对照组术后3个月ADL分级Ⅰ级2例,Ⅱ级4例,Ⅲ级6例,Ⅳ级7例,Ⅴ级8例.观察组预后良好率(57.5％,23/40)明显高于对组(31.6％,12/38;P=0.021).结论 与分次双侧去骨瓣减压术相比,预见性双侧平衡去骨瓣减压术治疗重型颅脑损伤可有效降低病死率及并发症发生率,改善病人预后.
Abstract
Objective To explore the clinical efficacy of predictive bilateral balanced decompressive craniectomy for patients with severe traumatic brain injury (sTBI). Methods The medical records of 78 patients with sTBI admitted from January 2019 to January 2023 were retrospectively analyzed. Forty patients were treated with predictive bilateral balanced decompressive craniectomy (observation group),and 38 patients were treated with staged bilateral decompressive craniectomy (control group). The mortality rate and the incidence of complications (including intracranial rebleeding,brain bulge,hydrocephalus,and intracranial infection) at 3 months after surgery were compared. The prognosis was evaluated based on the Activities of Daily Living (ADL) classification at 3 months after surgery,where grades Ⅰ～Ⅲ were considered good prognosis and grades Ⅳ～Ⅴ were considered poor prognosis. Results The mortality rate at 3 months after surgery in the observation group (10.0％,4/40) was significantly lower than that (28.9％,11/38) in the control group (P=0.034). The incidence of postoperative complications in the observation group (22.5％,9/40) was significantly lower than that (44.7％,17/38) in the control group (P=0.037). At 3 months after surgery,the rate of good prognosis in the observation group (57.5％,23/40) was significantly higher than that (31.6％,12/38) in the control group (P=0.021). Conclusions Compared with staged bilateral decompressive craniectomy,predictive bilateral balanced decompressive craniectomy for patients with sTBI can effectively reduce the mortality rate and the incidence of complications and improve the prognosis of patients.
维普
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