张家富

【摘要】 目的：探讨双侧标准外伤大骨瓣开颅手术治疗重型颅脑损伤的临床效果。方法：以本院2009年10月-2014年10月收治的120例重型颅脑损伤患者作为研究对象，根据治疗方案的不同将其分为对照组和观察组，每组60例。对照组给予双额冠状骨瓣开颅去骨瓣减压术，观察组则采用双侧标准外伤大骨瓣开颅去骨瓣减压术进行治疗。术后对两组患者的临床疗效、并发症发生情况、颅内压变化等进行对比。结果：观察组术后第3天和第7天的颅内压分别为（18.17±3.39）、（15.60±2.70）mm Hg，均明显低于对照组的（26.23±4.34）mm Hg和（21.50±3.51）mm Hg，差异均有统计学意义（P<0.05）。观察组患者治疗总有效率76.67%明显高于对照组的50.00%，差异有统计学意义（ 字2=7.834，P=0.013）。观察组患者的迟发性血肿和脑积水发生率分别为10.00%、3.33%，均明显低于对照组的23.33%和15.00%，差异均有统计学意义（P<0.05），而两组患者脑脊液漏和颅内感染发生率比较差异均无统计学意义（P>0.05）。结论：双侧标准外伤大骨瓣开颅减压术能够有效低降低颅内压，临床安全性可靠，值得推广。

【关键词】 双侧标准外伤大骨瓣开颅手术； 双额冠状骨瓣开颅去骨瓣减压术； 重型颅脑损伤； 临床效果

Clinical Effect Analysis of Bilateral Standard Large Trauma Craniectomy Operation for the Treatment of Severe Craniocerebral Injury/ZHANG Jia-fu.//Medical Innovation of China，2016，13（09）：132-135

【Abstract】 Objective：To discuss the clinical effect of bilateral standard large trauma craniectomy operation for the treatment of severe craniocerebral injury.Method：One hundred and twenty patients with severe craniocerebral injury admitted to our hospital from October 2009 to October 2014 were chosen as the research objects.All patients were divided into the control group and the observation group according to the different treatment method.The control group was treated with double frontal coronal bone flap craniotomy，while the observation group was treated with bilateral standard large trauma craniectomy operation.The clinical effect，incidence of the complications，changes of intracranial pressure between the two groups after operation were compared.Result：The intracranial pressure of the observation group at the 3rd day and 7th day after operation were （18.17±3.39）mm Hg and（15.60±2.70）mm Hg，which were significantly lower than （26.23±4.34）mm Hg and （21.50±3.51）mm Hg of the control group，the differences were statistical significance（P<0.05）.The total effective rate of observation group was 76.67%，which was significantly higher than 50.00% of the control group，the difference was statistically significant（字2=7.834，P=0.013）.The incidence of delayed hematoma and hydrocephalus of observation group were 10.00% and 3.33%，which were significantly lower than 23.33% and 15.00% of the control group，the differences were statistically significant（P<0.05）.There were no statistically significant differences in the incidence of cerebrospinal fluid leakage and intracranial infection between the two groups（P>0.05）.Conclusion：Bilateral standard large trauma craniectomy can effectively reduce the intracranial pressure，it has a reliable clinical safety and is worthy of promotion.

【Key words】 Bilateral standard large trauma craniectomy operation； Double frontal coronal bone flap craniotomy； Severe craniocerebral injury； Clinical effect

First-authors address：The Peoples Hospital of Yiyuan County in Zibo City，Yiyuan 256100，China

doi：10.3969/j.issn.1674-4985.2016.09.038

重型颅脑损伤是临床神经外科常见危急重症，临床上通常将患者昏迷时间多于6 h或者清醒后再次昏迷定义为重型颅脑损伤。随着现代工业的迅速发展，根据调查显示，颅脑损伤的致死率在我国已居前位，而且患者术后的伤残率也较高，重型颅脑损伤病情复杂多变，时刻威胁着患者的生命[1]。对于如何有效地治疗重型颅脑损伤已成为神经外科的难题，随着医疗技术水平的不断提高，20世纪90年代，经研究发现对于急性幕上颅内血肿、恶性颅内高压等患者采用标准大骨瓣开颅手术能够取得很好的治疗效果[2]。为了更好地研究双侧标准外伤大骨瓣开颅手……