单、双侧去骨瓣减压对单侧重型颅脑损伤术中脑膨出的疗效差异

目的:探讨在单侧或以单侧为主的重型颅脑损伤病例中,何种手术方式更适宜处理手术中出现的急性脑膨出。方法:对我科自2008年5月至2010年12月收治的以单侧为主的重型颅脑损伤且术中出现急性脑膨出的52例临床资料进行回顾性分析,研究单、双侧去骨瓣减压术对患者颅内压(ICP)及伤后6个月时的GOS评分的影响。结果:单侧去骨瓣减压患者29例,分为恢复良好组(GOS 4-5分,n=6),不良组(GOS 2-3分,n=9)和死亡组(GOS 1分,n=14);双侧去骨瓣减压患者23例亦分为恢复良好组(n=6),不良组(n=12)和死亡组(n=5);两种减压术的死亡率差异显著(P<0.05)。单侧和双侧去骨瓣减压术均明显降低ICP(P<0.05),但双侧减压的存活组其术后ICP(17.2±4.2 mmHg)显著低于单侧减压的存活组(25.0±5.4 mmHg)(P<0.05)。结论:对以单侧为主的重型颅脑损伤,同次行双侧去骨瓣减压术较单侧减压更能有效降低术中急性脑膨出所致高颅压,降低死亡率。

Different Effect between Unilateral and Bilateral Decompressive Craniectomy on Acute Encephalocel During Surgery in Patients with Unilateral Severe Brain Injury

Objective: To investigate a suitable way of solving acute encephalocel during surgery in patients with severe brain injury located(mainly) unilaterally.Methods: The clinical record of 52 patients who suffered from severe brain injury located(mainly) unilater-ally and underwent acute encephalocel during surgery in our department from May 2008 to December 2010 were analyzed retrospectively.The influence of unilateral and bilateral decompressive craniectomy on intracranial pressure(ICP) and Glasgow Outcome Scale(GOS) at the 6th month post-trauma were analyzed.Results: 29 patients undergoing unilateral decompressive craniectomy were divided into favor-able outcome group(GOS 4~5,n=6),unfavorable group(GOS 2~3,n=9) and Death(GOS 1,n=14);23 patients undergoing bilateral decom-pressive craniectomy were divided into favorable group(n=6),unfavorable group(n=12) and Death(n=5).The mortality of unilateral and bilateral decompressive craniectomy were obviously different(P<0.05).Both of them reduced ICP significantly(P<0.05).The ICP of survivors undergoing bilateral decompressive craniectomy(17.2±4.2 mmHg)was obviously lower than that of survivors undergoing unilateral craniectomy(25.0±5.4 mmHg) P<0.05).Conclusions: Bilateral decompressive craniectomy can decrease high level of ICP and mortality more obviously compared with unilateral craniectomy,with regard to acute encephalocel during surgery in patients with se-vere brain injury located(mainly) unilaterally.