去骨瓣减压术后早期颅骨成形术对重型颅脑损伤患者神经功能恢复及预后的改善作用
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摘要
目的:探讨重型脑损伤患者行去骨瓣减压术后早期颅骨成形术在临床治疗中的应用价值及患者神经功能恢复与预后改善。方法:筛选2014年7月—2017年7月在我院接受治疗的90例重型颅脑外伤患者作为研究对象,随机分成早期组(n=45)与对照组(n=45)。早期组行颅骨成形术于去骨瓣减压术后2个月内实施,对照组则于术后5个月后实施修补术,对两组患者的神经功能恢复及其预后的生活质量的改善情况进行比较。结果:(1)早期组颅骨成形术中失血量、手术时间、皮瓣游离时间较对照组减少(P <0. 05);(2)颅骨成形术后4周对比两组的GOS评分、KPS评分、NIHSS评分差异无统计学意义,术后6个月早期组GOS评分上升至(4. 1±0. 1)分,KPS评分提升至(71. 63±8. 1)分,均明显高于对照组(P <0. 05),NIHSS评分下降至(2. 6±0. 8)分,显著低于对照组(P <0. 05);(3)早期组在术后并发症和神经功能缺损发生率明显低于对照组(P <0. 05);(4)经世界卫生组织编制的生存质量量表评分得出早期组生存质量相比术前和对照组有明显改善(P <0. 05)。结论:采用早期颅骨成形术治疗重型颅脑创伤患者,术后神经功能恢复情况较好,预后改善明显,对提升重型颅脑损伤患者的生活质量有积极意义。
Objective: To investigate the clinical value of early cranioplasty after decompressive craniectomy in severe brain injury patients,and to improve neurological function and prognosis. Methods: A total of 90 patients with severe craniocerebral trauma treated in our hospital from July 2014 to July 2017 were selected as the research subjects,randomly divided into the early group( n = 45) and the control group( n = 45). In early group,cranioplasty was performed 2 months after decompressive craniectomy. In the control group,postoperative repair was performed 5 months after operation. The recovery of neurological function and the improvement of quality of life in two groups were compared. Results:( 1) The early group in the operation time,blood loss,flap free time compared with the control group,and the difference was significant( P < 0. 05);( 2) cranioplasty after 1 month compared to the two groups of GOS score,KPS score and NIHSS score had no significant difference,after6 months early group GOS score increased to( 4. 1 ± 0. 1) points,KPS score increased to( 71. 63 ± 8. 1),were significantly higher than those of the control group( P < 0. 05),the NIHSS score decreased to( 2. 6 ± 0. 8) %,significantly lower than that in the control group( P < 0. 05);( 3) the incidence of complications in the postoperative and nerve function defect in early group was significantly lower than the control group( P < 0. 05);( 4) the amount of quality of life scale compiled by WHO that the quality of survival compared to early group and control group were obviously improved( P < 0. 05). Conclusion: Early cranioplasty is effective in the treatment of severe traumatic brain injury,and it has a positive effect on improving the quality of life of patients with severe craniocerebral injury.
Objective: To investigate the clinical value of early cranioplasty after decompressive craniectomy in severe brain injury patients,and to improve neurological function and prognosis. Methods: A total of 90 patients with severe craniocerebral trauma treated in our hospital from July 2014 to July 2017 were selected as the research subjects,randomly divided into the early group( n = 45) and the control group( n = 45). In early group,cranioplasty was performed 2 months after decompressive craniectomy. In the control group,postoperative repair was performed 5 months after operation. The recovery of neurological function and the improvement of quality of life in two groups were compared. Results:( 1) The early group in the operation time,blood loss,flap free time compared with the control group,and the difference was significant( P < 0. 05);( 2) cranioplasty after 1 month compared to the two groups of GOS score,KPS score and NIHSS score had no significant difference,after6 months early group GOS score increased to( 4. 1 ± 0. 1) points,KPS score increased to( 71. 63 ± 8. 1),were significantly higher than those of the control group( P < 0. 05),the NIHSS score decreased to( 2. 6 ± 0. 8) %,significantly lower than that in the control group( P < 0. 05);( 3) the incidence of complications in the postoperative and nerve function defect in early group was significantly lower than the control group( P < 0. 05);( 4) the amount of quality of life scale compiled by WHO that the quality of survival compared to early group and control group were obviously improved( P < 0. 05). Conclusion: Early cranioplasty is effective in the treatment of severe traumatic brain injury,and it has a positive effect on improving the quality of life of patients with severe craniocerebral injury.
引文
[1]熊志云,艾文兵,章熙娜,等.早期气管切开对重型颅脑损伤患者肺部感染及预后的影响〔J〕.中华医院感染学杂志,2014,24(4):973-975.
[2]王康,孙晓川,刘科.重型颅脑损伤颅内压监测临床研究进展〔J〕.创伤外科杂志,2014,16(4):370-372,379.
[3]王崇谦,汤志伟,杨智勇,等. 86例重型颅脑损伤手术治疗临床分析〔J〕.昆明医科大学学报,2012,33(9):110-114.
[4] Honeybul S,Ho KM. Decompressive Craniectomy-A narrative re-view and discussion〔J〕. Australian Critical Care,2014,27(2):85-91.
[5] Abhishek Songara,Rakesh Gupta,Nilesh Jain,et al. Early Cranio-plasty in Patients With Posttraumatic Decompressive Craniectomyand Its Correlation with Changes in Cerebral Perfusion Parametersand Neurocognitive Outcome〔J〕. World Neurosurgery,2016,94:303-308.
[6]曾年菊,姚兴发,何博,等.不同时期颅骨修补对重型颅脑损伤患者康复疗效的影响〔J〕.中国实用神经疾病杂志,2015,18(22):37-38.
[7]罗小程.重症颅脑损伤患者术后NIHSS评分的影响因素分析〔J〕.临床与病理杂志,2016,36(8):1108-1112.
[8]刘嘉欣,夏萍. WHO生存质量量表在我国患者中的应用现状〔J〕.中国社会医学杂志,2013,30(3):203-206.
[9] Patrick Schuss,Valeri Borger,Agi Guresir,et al. Cranioplasty andVentriculoperitoneal Shunt Placement after Decompressive Craniec-tomy:Staged Surgery Is Associated with Fewer Postoperative Com-plications〔J〕. Workld Neuosurgery,2015,84(4):1051.
[10]李涛,丁昊,蓝美锐.去骨瓣减压术后早期颅骨修补联合脑室腹腔分流术的疗效分析〔J〕.吉林医学,2013,34(16):3096.
[11]黄银兴,赵琳,等.脑外伤去骨瓣减压术后颅骨缺损修补手术时机的临床研究〔J〕.中国伤残医学,2013,21(7):22-24.
[12]刘宇梁,伏光辉,李凤利,等.脑外伤后早期颅骨修补术联合脑室腹腔分流术对预后的影响〔J〕.现代中西医结合杂志,2015,24(25):2806-2808.
[13] Jong Min Lee,Kum Whang,Sung Min Cho,et al. Factors Affect-ing Optimal Time of Cranioplasty:Brain Sunken Ratio〔J〕. Kore-an J Neurotrauma,2017,13(2):113-118.
[2]王康,孙晓川,刘科.重型颅脑损伤颅内压监测临床研究进展〔J〕.创伤外科杂志,2014,16(4):370-372,379.
[3]王崇谦,汤志伟,杨智勇,等. 86例重型颅脑损伤手术治疗临床分析〔J〕.昆明医科大学学报,2012,33(9):110-114.
[4] Honeybul S,Ho KM. Decompressive Craniectomy-A narrative re-view and discussion〔J〕. Australian Critical Care,2014,27(2):85-91.
[5] Abhishek Songara,Rakesh Gupta,Nilesh Jain,et al. Early Cranio-plasty in Patients With Posttraumatic Decompressive Craniectomyand Its Correlation with Changes in Cerebral Perfusion Parametersand Neurocognitive Outcome〔J〕. World Neurosurgery,2016,94:303-308.
[6]曾年菊,姚兴发,何博,等.不同时期颅骨修补对重型颅脑损伤患者康复疗效的影响〔J〕.中国实用神经疾病杂志,2015,18(22):37-38.
[7]罗小程.重症颅脑损伤患者术后NIHSS评分的影响因素分析〔J〕.临床与病理杂志,2016,36(8):1108-1112.
[8]刘嘉欣,夏萍. WHO生存质量量表在我国患者中的应用现状〔J〕.中国社会医学杂志,2013,30(3):203-206.
[9] Patrick Schuss,Valeri Borger,Agi Guresir,et al. Cranioplasty andVentriculoperitoneal Shunt Placement after Decompressive Craniec-tomy:Staged Surgery Is Associated with Fewer Postoperative Com-plications〔J〕. Workld Neuosurgery,2015,84(4):1051.
[10]李涛,丁昊,蓝美锐.去骨瓣减压术后早期颅骨修补联合脑室腹腔分流术的疗效分析〔J〕.吉林医学,2013,34(16):3096.
[11]黄银兴,赵琳,等.脑外伤去骨瓣减压术后颅骨缺损修补手术时机的临床研究〔J〕.中国伤残医学,2013,21(7):22-24.
[12]刘宇梁,伏光辉,李凤利,等.脑外伤后早期颅骨修补术联合脑室腹腔分流术对预后的影响〔J〕.现代中西医结合杂志,2015,24(25):2806-2808.
[13] Jong Min Lee,Kum Whang,Sung Min Cho,et al. Factors Affect-ing Optimal Time of Cranioplasty:Brain Sunken Ratio〔J〕. Kore-an J Neurotrauma,2017,13(2):113-118.