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目的比较双侧去骨瓣减压开颅术与单侧外伤大骨瓣减压窗术治疗重型对冲性颅脑损伤的临床效果。方法选取攀枝花市仁和区人民医院2013年10月—2015年10月收治的重型对冲性颅脑损伤患者84例,按照随机分配原则分为对照组和研究组,各42例。对照组患者采取单侧外伤大骨瓣减压术治疗,研究组患者采取双侧去骨瓣减压开颅术治疗。比较两组患者的临床效果,术后1、3、7 d颅内压情况及术后并发症发生情况。结果研究组患者临床效果优于对照组(P<0.05)。术后1 d,两组患者颅内压比较,差异无统计学意义(P>0.05);术后3、7 d,研究组患者颅内压低于对照组(P<0.05)。研究组患者切口疝、急性脑膨出发生率低于对照组(P<0.05)。结论双侧去骨瓣减压开颅术治疗重型对冲性颅脑损伤临床效果优于单侧外伤大骨瓣减压窗术,可有效降低并控制颅内压,减少不良事件发生,改善患者预后。
Objective To compare the clinical effects of bilateral craniotomy decompression craniotomy with unilateral traumatic large bone flap decompression window in the treatment of severe hemorrhagic head injury. Methods Eighty-four patients with severe hemorrhagic head injury who were admitted to Renhe District People’s Hospital of Panzhihua City from October 2013 to October 2015 were divided into control group and study group according to the principle of random distribution. Patients in the control group were treated with unilateral traumatic large bone flap decompression. The study group was treated with bilateral craniotomy decompression craniotomy. The clinical effects, postoperative 1, 3, 7 d intracranial pressure and postoperative complications were compared between the two groups. Results The clinical effect of the study group was better than that of the control group (P <0.05). At 1 d after operation, the intracranial pressure was no significant difference between the two groups (P> 0.05). At 3 and 7 days after operation, the intracranial pressure in the study group was lower than that in the control group (P <0.05). The incidence of incisional hernia and acute encephalocele in the study group was lower than that in the control group (P <0.05). Conclusion Bilateral craniotomy decompressive craniotomy for severe hemorrhagic head injury is better than unilateral trauma craniectomy decompression window, which can effectively reduce and control intracranial pressure, reduce the incidence of adverse events and improve the prognosis of patients .