闫海光

【摘要】 目的：探討重型颅脑外伤患者采用改良标准大骨瓣开颅手术治疗对患者脑血流动力学的影响。方法：选取2017年1月-2019年7月本院收治的重型颅脑外伤合并高血压患者171例，按照抽签的方法将其分为对照组（n=85）和研究组（n=86）。对照组采用常规去骨瓣减压术治疗，研究组采用改良标准大骨瓣开颅手术治疗。比较两组患者的脑血流动力学指标、临床指标、治疗效果、NIHSS评分及生活质量评分。结果：两组患者镇静前和镇静1 h的心率、血压比较，差异均无统计学意义（P>0.05）;镇静5、30 min，研究组患者的心率及血压均低于对照组（P<0.05）。两组患者镇静期间的血氧饱和度比较，差异均无统计学意义（P>0.05）。研究组的下床时间、住院时间均短于对照组，再出血率低于对照组，差异均有统计学意义（P<0.05）。治疗后，研究组患者的NIHSS评分低于对照组，生活质量评分高于对照组，差异均有统计学意义（P<0.05）。研究组的治疗总有效率高于对照组，差异有统计学意义（P<0.05）。结论：改良标准大骨瓣开颅手术治疗重型颅脑外伤患者临床效果较为显著，同时患者的脑血流动力学不会出现较为明显的波动，有利于患者的术后恢复，值得在临床上推广应用。

【关键词】 重型颅脑外伤 改良标准大骨瓣开颅手术 血流动力学 NIHSS评分

[Abstract] Objective： To investigate the effect of modified standard large bone flap craniotomy on cerebral hemodynamics in patients with severe craniocerebral injury. Method： A total of 171 patients with severe craniocerebral injury combined with hypertension admitted to our hospital from January 2017 to July 2019 were selected. They were divided into control group （n=85） and study group （n=86） by lottery. The control group was treated with conventional bone flap decompression， while the study group was treated with modified standard large bone flap craniotomy. Cerebral hemodynamic index， clinical index， therapeutic effect， NIHSS score and quality of life score were compared between the two groups. Result： There were no significant differences in heart rate and blood pressure between 2 groups before sedation and 1 h after sedation （P>0.05）; after 5， 30 minutes of sedation， the heart rate and blood pressure in the study group were lower than those in the control group （P<0.05）. There were no statistical significance in blood oxygen saturation between the two groups during sedation （P>0.05）. The time of getting out of bed and hospital stay in the study group were shorter than those in the control group， and the rate of rebleeding was lower than that in the control group， the differences were statistically significant （P<0.05）.  After treatment， the NIHSS score of the study group was lower than that of the control group， and the quality of life score was higher than that of the control group， the differences were statistically significant （P<0.05）. The total effective rate of the study group was higher than that of the control group， the difference was statistically significant （P<0.05）.Conclusion： The clinical effect of modified standard large bone flap craniotomy in the treatment of patients with severe craniocerebral injury is relatively significant， and the cerebral hemodynamics of patients will not fluctuate significantly， which is conducive to postoperative recovery of patients， and worthy of clinical promotion and application.

[Key words] Severe craniocerebral injury Modified standard large bone flap craniotomy HemodynamicsNIHSS score

颅脑损伤是一种常见外伤，可单独存在也可与其他疾病合并存在，而造成该疾病的原因主要是交通事故、工伤、高处坠落等，给患者的生命造成严重威胁[1-3]。根据病情的严重程度分为四种类型：轻、中、重及特重，患者的病情越重并发症也越多、病情进展越快、治疗的难度也越大，同时患者也更容易死亡，不仅要对患者进行及时的诊断及有效的治疗，还要给予患者精神上及身体上的综合性护理，使患者脱离生命危险，帮助患者更快康复，同时降低致残率[4]。在神经外科急危重症临床中以高血压脑出血最为常见，该疾病会对患者的脑血管及脑组织造成损害，引起颅内急性血肿占位效应，从而对病理的改变也会造成一系列不良的影响，该疾病具有发病急、致死致残率较高的特点，而及时地将颅内血肿清除是治疗的关键所在[5]。因此……