Comparison of the effect of standard decompressive craniectomy and controlled decompression in the treatment of severe craniocerebral injury
Objective To explore the clinical effect of standard decompressive craniectomy and controlled decompression in the treatment of severe craniocerebral injury.Methods 80 patients with severe craniocerebral injury who received surgical treatment were divided into a control group and an observation group according to random number table method,with 40 cases in each group.The control group was treated with standard decompressive craniectomy,and the observation group was treated with controlled decompression.The levels of nerve injury related factors at 48 h postoperatively,Glasgow coma score before and after surgery,postoperative complications and cerebral perfusion pressure were compared between the two groups.Results The levels of neuron-specific enolase and S-100B protein in the observation group were(5.8±0.5)ng/ml and(0.7±0.1)μg/L at 48 h postoperatively,which were significantly lower than(15.9±1.8)ng/ml and(1.9±0.3)μg/L in the control group(P<0.05).At 7 d postoperatively,the Glasgow coma score in both groups was higher than that before surgery,and the Glasgow coma score in the observation group was(10.7±2.2)points,which was significantly higher than(7.9±1.5)points in the control group(P<0.05).The incidence of postoperative complications in the observation group was 5.0%,which was significantly lower than 30.0%in the control group(P<0.05).On postoperative day 1,3 and 7,the cerebral perfusion pressure in the observation group were(89.7±5.8),(95.3±6.8)and(99.7±7.3)mm Hg(1 mm Hg= 0.133 kPa),which were significantly higher than(57.9±5.7),(59.9±6.2)and(63.7±4.9)mm Hg in the control group(t=24.732,24.330,25.897;P=0.000,0.000,0.000<0.05).Conclusion For patients with severe craniocerebral injury,controlled decompression combined with mild hypothermia can reduce iatrogenic injury,ensure cerebral perfusion pressure and promote the recovery of neurological function,and it has fewer complications and high safety.
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