控制性減壓術(shù)防治老年重型顱腦損傷并發(fā)腦梗死的可行性研究

1、控制性減壓術(shù)防治老年重型顱腦損傷并發(fā)腦梗死的可行性研究【摘要】目的：研究控制性減壓術(shù)對防治老年重 型顱腦損傷并發(fā)腦梗死的可行性。方法：收集老年重型顱腦 損傷患者共60例，對照組30例患者采用標準大骨瓣減壓術(shù), 觀察組30例患者采用控制性減壓術(shù)。術(shù)后統(tǒng)計兩組患者的 手術(shù)效果，患者有無腦水腫及其嚴重程度，患者有無腦梗死 及其體積大小，術(shù)后48 h兩組患者雙側(cè)大腦中動脈血流動 力學(xué)及術(shù)后6個月的恢復(fù)情況。結(jié)果：觀察組總有效率為 96. 67%,比對照組的76. 67%高。觀察組腦水腫發(fā)生率為 16. 67%,明顯低于對照組的36. 67%o腦梗死的發(fā)生率為 6.67%,亦低于對照組的23. 33%o

2、結(jié)論：控制性減壓術(shù)防治 老年重型顱腦損傷是可行的?！娟P(guān)鍵詞】控制性減壓術(shù)；重型顱腦傷；腦梗死中圖分類號r743文獻標識碼b文章編號1674-6805 (2014) 31-0134-02controlling decompression feasibility study in elderly patients with cerebral infarction with severe brain injury prevention/hu xiao-min , liu kun , tan cong. /chinese and foreign medical research, 2014, 12 (

3、31)： 134-135abstract objective： to study the prevention and treatment of senile controlled decompression surgery for severe brain injury complicated by cerebral infarction feasibility.method : period in elderly patients with severe traumatic brain injury , namely control group and observation group

4、and control group of 30 patients were treated with standard large trauma reduction buckling surgery, observation group of 30 patients were treated with controlled decompression. generally two groups of patients with postoperative statistical effect , whether patients with cerebral edema and its seve

5、rity, whether patients with cerebral infarction and its dimensions, after 48 h after the two groups of patients with bilateral cerebral hemodynamics and arterial blood recovery after 6 months .result： the total effective rate of the observation group was 96.67%, was higher than the control group&quo

6、t; s 76. 67%.the cerebral edema incidence of the observation group was 16. 67%, was significantly lower than the control group， s 36. 67%. the edema incidence of cerebral infarction of the observation group was 6. 67%, was lower than the control group" s 23.33%.conclusion： controlling decompres

7、sion severe brain injury prevention in elderly is clinically feasible .key words controlling decompression； severe traumatic brain injury； cerebral infarctionfirst-author' s address： wusheng county people' s hospital, wusheng 638400, china重型顱腦損傷發(fā)生多由于高能創(chuàng)傷使得顱內(nèi)血腫擠壓、 創(chuàng)傷后腦水腫加重、顱內(nèi)壓急劇增髙，從而引起腦的進一步 損

8、傷，嚴重的可導(dǎo)致死亡1-3 o目前神經(jīng)外科常用的減壓 手段有標準外傷大骨瓣減壓術(shù)和控制性減壓術(shù)，而標準外傷 大骨瓣減壓術(shù)防治腦梗死的效果不是很理想4-5。本研究 通過對收集的患者采用標準大骨瓣減壓術(shù)和控制性減壓術(shù) 治療，多數(shù)患者經(jīng)治療后病情好轉(zhuǎn)情況好于以標準大骨瓣減 壓術(shù)治療的患者。2010年8月-2012年8月筆者所在醫(yī)院老 年重型顱腦損傷患者60例，采用標準大骨瓣減壓術(shù)和控制 性減壓術(shù)對其進行治療，現(xiàn)報告如下。1資料與方法1. 1 一般資料收集老年重型顱腦損傷患者共60例，均無嚴重心血管 疾病、肝腎功能障礙、藥物過敏史以及近期輸血史。其中男 35例，女25例：根據(jù)病因分為車禍（26例），高空墜落（26 例），打擊傷（14例）；根據(jù)病情可分為廣泛腦挫裂傷（20 例