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标准外伤大骨瓣改良术式与传统术式治疗老年人重型颅脑损伤的疗效比较

Application of craniotomy operation in aged patients with severe craniocerebral injury

摘要:

目的:探究并分析标准外伤大骨瓣改良术式(缓慢减压)以及标准外伤大骨瓣传统术式(骤然减压)用于老年重型颅脑损伤( SCCI )患者的治疗效果。方法选取老年重型颅脑损伤( SCCI )患者100例,按照数字表法随机分为对照组以及观察组,每组各50例。对照组采用常规方法(标准外伤大骨瓣传统术式)治疗,观察组采用标准外伤大骨瓣改良术式进行手术。观察并记录两组患者术后疗效以及术后并发症发生情况。结果两组术后1 d、3 d、5 d、15 d颅内压分别为(272.3±19.1)mmHg、(285.4±18.2)mmHg、(218.2±18.3)mmHg、(168.4±17.3) mmHg;(302.1±23.1) mmHg、(310.3±19.2) mmHg、(221.1±19.2) mmHg、(148.2±16.4)mmHg,较术前均明显改变,且随时间逐渐降低,对照组颅内压降低较观察组更加明显;观察组癫痫、脑梗死、脑积水发生率分别为2.0%、6.0%、0.0%,明显低于对照组(30.0%、36.0%、26.0%),组间差异均有统计学意义(χ2=14.85、13.56、14.96,均P<0.05);观察组预后良好、中残例数明显多于对照组,而重残以及植物状态患者明显少于对照组(χ2=4.88、3.93、4.33、7.44,均P<0.05)。结论标准外伤大骨瓣改良术式能有效减少老年重症患者术后颅内压波动,降低并发症发生率,预后情况较好,提高治疗效果。

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Objective To explore and analyze the effect of standard large trauma improved operation ( slow decompression ) and standard large trauma conventional surgical procedures ( sudden decompression ) in the treatment of elderly patients with severe craniocerebral injury ( SCCI) .Methods 100 elderly patients with SCCI were randomly divided into the control group and the observation group ,50 cases in each group .The control group was treated with conventional methods ( standard large trauma traditional surgical treatment ) , the observation group was treated with standard large trauma surgery improved operation .The effects and postoperative complications were observed and recorded.Results 1d,3d,5d,15d after operation,the intracranial pressure of the two groups were (272.3 ±19.1)mmHg, (285.4 ±18.2) mmHg,(218.2 ±18.3) mmHg,(168.4 ±17.3) mmHg;(302.1 ±23.1) mmHg,(310.3 ± 19.2)mmHg,(221.1 ±19.2)mmHg,(148.2 ±16.4)mmHg,which were changed significantly compared with preop-eration,the intracranial pressure gradually decreased as time passed ,the decrease of intracranial pressure in the con-trol group was more obvious than the observation group .The incidence rates of epilepsy ,cerebral infarction ,hydroceph-alus in the observation group were 2.0%,6.0%,0.0%,which were significantly lower than those in the control group (30.0%,36.0 %,26.0%),the differences between the two groups were significant (χ2 =14.85,13.56,14.96,all P<0.05).The number of patients with good prognosis ,the residual in the observation group were significantly more than the control group , while the number of severely disabled and vegetative state patients in the observation group were significantly less than the control group ,(χ2 =4.88,3.93,4.33,7.44,all P<0.05).Conclusion Standard large trauma improved operation ( slow decompression ) can effectively reduce intracranial pressure in elderly patients with severe fluctuations ,reduce the incidence of complications ,improve treatment prognosis ,it should be popularized in clinical practice .

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