【摘要】 目的探讨双侧均衡阶梯式减压在去骨瓣减压术治疗创伤后急性弥漫性脑肿胀(PADBS)重型颅脑损伤效果。方法分析本科2014年3月至2017年4月收治的PADBS重度脑创伤患者84例,治疗组52例采用双侧均衡、阶梯式减压策略进行双侧标准大骨瓣减压手术,对照组32例采用常规大骨瓣减压手术。比较两组术中脑膨出、术后颅内压(ICP)降低效果和并发症的发生率,并于术后6个月应用GOS评价救治效果。结果入院时两组患者ICP差异无统计学意义,而治疗组术后1d ICP较对照组减低显著,达到20.4mmHg(P<0.05);与对照组比较,治疗组术中脑膨出、术后迟发血肿、脑干扭曲变形、术后切口疝、大面积脑梗死的发生率均明显降低(P<0.05);治疗组6个月后良好率(46.15%)较对照组(19.23%)提高26.92%(P<0.05),而死亡率下降12.00%。结论应用双侧均衡、阶梯式减压策略治疗PADBS能够有效降低ICP,降低术中脑膨出和术后并发症发生率,并改善患者预后。更多还原

【Abstract】 Objective To investigate the effects of bilateral decompressive craniectomy with balanced and stepped strategy in treatment of severe craniocerebral injury with post-traumatic acute diffuse brain swelling(PADBS). Method 84 patients with PADBS after severe head injuries were analyzed retrospectively from Mar 2014 to April 2017. 52 patients underwent bilateral decompressive craniectomy with balanced and stepped strategy while 32 cases were performed that of routine standard large bone. Intra-operative encephalocele, post-operative complications and Glasgow Outcome Scale(GOS) at the 6 th month after operation were investigated respectively. Results There was no significant difference between treatment and control group. However, post-operative ICP was significantly lower in treatment group than that in control group(P<0.05), dropped to 20.4 mmHg. Compared with control group, the incidences of intra-operative encephalocele and post-operative complications were significantly lower in treatment group(P<0.05), and the rate of 6-month favorable outcome in treatment group was 46.15 %,and was 26.92% higher than in control group(19.23%)(P<0.05), with 12.00% of mortality drop. Conclusion Bilateral decompressive craniectomy with balanced and stepped strategy could decrease the ICP, intra-operative encephalocele and post-operative complications in severe craniocerebral injury patients with PADBS,and finally improve the prognosis.更多还原