马宇宏

[摘要]目的 分析改良標准外伤大骨瓣开颅术治疗重型颅脑外伤的临床效果。方法 选取2014年3月～2018年4月在我院接受手术治疗的40例重型颅脑外伤患者作为研究对象，根据电脑随机编码法分为对照组和观察组，每组20例。对照组采用标准外伤大骨瓣开颅术进行治疗，观察组采用改良标准外伤大骨瓣开颅术进行治疗。比较两组的颅内压变化、格拉斯哥昏迷评分（GCS）、手术效果以及术后并发症。结果 观察组术后5 d的颅内压（15.36±2.13 mmHg）低于对照组[（21.58±2.20）mmHg]，差异有统计学意义（P<0.05）。观察组患者术后3、6个月的GCS评分[（10.15±2.32）、（13.65±2.18）分]均高于对照组[（8.10±2.01）、（10.12±2.15）分]，差异有统计学意义（P<0.05）。观察组患者的手术总有效率（90.00%）高于对照组（60.00%），差异有统计学意义（P<0.05）。观察组患者的术后并发症总发生率（5.00%）低于对照组（30.00%），差异有统计学意义（P<0.05）。结论 改良标准外伤大骨瓣开颅术治疗重型颅脑外伤的效果较理想。

[关键词]重型颅脑外伤；改良标准外伤大骨瓣开颅术；效果

[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0054-03

[Abstract] Objective To analyze the clinical effect of modified standard trauma large craniotomy with bone flap operation treating severe craniocerebral trauma. Methods Forty patients with severe craniocerebral trauma underwent surgical treatment in our hospital from March 2014 to April 2018 were selected as the study objects， and they were divided into the control group and observation group according to the computer random coding method， there were 20 cases in each group. The control group was treated with standard trauma large craniotomy with bone flap operation， while in the observation group were treated with modified standard trauma large craniotomy with bone flap operation. Intracranial pressure change， Glasgow coma scale （GCS） score， operative effect and the incidence of postoperative complications were compared between the two groups. Results The intracranial pressure of the observation group was （15.36±2.13） mmHg， which was lower than that of the control group （[21.58±2.20] mmHg） 5 days after operation， and the difference was statistically significant （P<0.05）. The GCS score of the observation group （[10.15±2.32]， [13.65±2.18] scores） 3 months and 6 months after operation were higher than those of the control group （[8.10±2.01]， [10.12±2.15] scores）， and the differences were statistically significant （P<0.05）. The total effective rate of the observation group （90.00%） was higher than that of the control group （60.00%）， and the difference was statistically significant （P<0.05）. The total incidence of postoperative complications in the observation group （5.00%） was lower than that in the control group （30.00%）， and the difference was statistically significant （P<0.05）. Conclusion The effect of modified standard trauma large craniotomy with bone flap operation treating severe craniocerebral trauma is more ideal.

[Key words] Severe craniocerebral trauma； Modified standard trauma large craniotomy with bone flap operation； Effect

殴打、高空坠落、车祸等原因都会损伤颅脑，引发颅脑外伤，以情绪消极、抑郁、躁动不安、妄想、失眠以及头晕等为主要症状[1]。随着交通事业的发展，颅脑外伤发病率逐渐升高，治疗颅脑外伤的关键在于及时纠正休克症状[2]，使脑组织血流灌注恢复，同时注意病情的变化，及时手术。改良标准外伤大骨瓣开颅术手术视野开阔，止血彻底，能及时修补撕裂的颅底硬脑膜，本研究为了分析其治疗重型颅脑外伤的效果，选取40例重型颅脑外伤患者进行研究，现报道如下。

1资料与方法

1.1一般资料

选取2014年3月～2018年4月在我院接受手术治疗的40例重型颅脑外伤患者作为研究对象，根据电脑随机编码法分为对照组和观察组，每组20例。观察组：男∶女=14∶6；年龄23～72岁，平均（54.10±9.25）岁；受伤原因：10例交通事故伤，5例高空坠落伤，3例殴打伤，2例其他伤。对照组：男∶女=13∶7；……