标准外伤大骨瓣减压术对外伤性多发性颅内血肿患者术后意识障碍恢复的影响

doi:10.13481/j.1671-587x.20160128

吉林大学学报(医学版) ›› 2016, Vol. 42 ›› Issue (01): 139-143.doi: 10.13481/j.1671-587x.20160128

标准外伤大骨瓣减压术对外伤性多发性颅内血肿患者术后意识障碍恢复的影响

郑旭, 张博, 刘建鹏, 张伟涛, 于金录, 杨洪发

吉林大学第一医院神经创伤外科, 吉林长春 130021

收稿日期:2015-09-11 发布日期:2016-01-26
通讯作者: 杨洪发,副教授,硕士研究生导师(Tel:0431-88782331,E-mail:fanghongfa@163.com) E-mail:fanghongfa@163.com
作者简介:郑旭(1988-),男,湖北省恩施市人,在读医学硕士,主要从事神经创伤修复方面的研究。
基金资助:
国家自然科学基金资助课题(81200888);吉林省科技厅科研基金资助课题(20130101149JC)

Influence of standard trauma craniectomy in conscious disturbance recovery in patients with traumatic multiple intracranial hematoma

ZHENG Xu, ZHANG Bo, LIU Jianpeng, ZHANG Weitao, YU Jinlu, YANG Hongfa

Department of Neourotrauma, First Hospital, Jilin University, Changchun 130021, China

Received:2015-09-11 Published:2016-01-26

摘要/Abstract

摘要：

目的: 观察标准外伤大骨瓣减压术(STC)后患者意识障碍恢复情况,探讨其在外伤性多发性颅内血肿(TMIH)治疗中的价值。方法: 收集2014年手术治疗的TMIH患者57例,其中行STC患者39例,行常规开颅手术18例,排除1个月内死亡、失联和占位病变等患者,分别随机选取STC组10例和对照组(常规开颅组)10例。通过重复测量方差分析以及Wilcoxon秩和检验对术前和术后24h、1周及1个月格拉斯哥昏迷量表(GCS)评分进行统计学分析。结果: 综合术后时间因素及术式因素进行分析,术后不同时间点GCS评分比较差异均有统计学意义(P<0.05),随术后时间延长,GCS评分呈逐步升高趋势。不同术式间GCS评分比较差异无统计学意义(P>0.05),不同术式对GCS评分整体恢复趋势相同,但在不同时间点GCS评分因术式不同存在差异。通过Wilcoxon秩和检验分析GCS评分变化率,与对照组比较,术后24h和术后1周时STC组GCS评分变化率明显升高(P<0.01),而术后1个月时GCS评分变化率差异无统计学意义(P>0.05)。结论: 与常规开颅手术比较,STC对术后7d内TMIH患者意识障碍的恢复作用明显,而对术后1个月患者意识障碍的恢复无明显改善作用。

关键词: 标准大骨瓣减压, 外伤性多发颅内血肿, 意识障碍, 重复检测方差分析, Wilcoxon秩和检验

Abstract:

Objective: To observe the conscious disturbance recovery in the patients with traumatic multiple intracranial hematoma (TMIH)after standard trauma craniectomy(STC),and to explore its value in the treatment of TMIH.Methods: The clinical data of TMIH patients with surgical treatments in 2014 were collected. The patients who dead within one month after surgery,could not be contacted or diagnosed with space-occupying lesions were excluded.According to surgical procedures,the patients were classified as STC group and control group (conventional craniotomy surgery).For each group,10 cases were randomly selected.Using repeated measurement of variance analysis and Wilcoxon rank sum test,the changes of Glasgow Coma Scale (GCS)scores were analyzed before operation and 24 h,1 week,1 month after operation. Results: There were significant changes of GCS at different time points (P< 0.05)by the comprehensive analysis of postoperative time factor and operation factor,which meaned that GCS showed a trend of gradual increase,along with the postoperative time prolongation.The postoperative time factor showed improvement effect on the GCS score,but there was no significant difference in GCS scores between different operation methods (P> 0.05).The GCS score overall recovery trend of different operative methods was the same,but at different time points the GCS score recovery had differences between the different operative methods.By Wilcoxon rank sum test analysis,the rates of GCS score changes were significantly different in STC group and control group(P<0.01)at the time points of 24 h and 1 week after operation.But there was no significant difference in the GCS score change between two groups 1 month after operation(P>0.05).Conclusion: Compared with conventional craniotomy surgery,STC has significant effect on the recovery of conscious disturbance 7 d after operation; but STC has no effect on the recovery of conscious disturbance of the patients 1 month after operation.

Key words: standard trauma craniectom, traumatic multiple intracranial hematoma, conscious disturbance, repeated measurement of variance analysis, Wilcoxon rank sum test

中图分类号:

R651.12

郑旭, 张博, 刘建鹏, 张伟涛, 于金录, 杨洪发. 标准外伤大骨瓣减压术对外伤性多发性颅内血肿患者术后意识障碍恢复的影响[J]. 吉林大学学报(医学版), 2016, 42(01): 139-143.

ZHENG Xu, ZHANG Bo, LIU Jianpeng, ZHANG Weitao, YU Jinlu, YANG Hongfa. Influence of standard trauma craniectomy in conscious disturbance recovery in patients with traumatic multiple intracranial hematoma[J]. Journal of Jilin University Medicine Edition, 2016, 42(01): 139-143.

参考文献

[1] Romodanov AP,Pedachenko EG.Multiple traumatic intracranial hematomas[J].Voprosy Neirokhirurgii,1975(4):3-9.

[2] Caroli M,Locatelli M,Campanella R,et al.Multiple intracranial lesions in head injury:clinical considerations,prognostic factors,management,and results in 95 patients[J].Surg Neurol,2001,56(2):82-88.

[3] Münch E,Horn P,Schürer L,et al.Management of severe traumatic brain injury by decompressive craniectomy[J].Neurosurgery,2000,47(2):315-322.

[4] Coplin WM,Cullen NK,Policherla PN,et al.Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury[J].J Trauma,2001,50(6):1050-1059.

[5] Cooper DJ,Rosenfeld JV,Murray L,et al.Decompressive craniectomy in diffuse traumatic brain injury[J].New Engl J Med,2011,364(16):1493-1502.

[6] Chen SH,Chen Y,Fang WK,et al.Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma[J].J Trauma,2011,71(6):1632-1636.

[7] Huang YH,Lee TC,Lee TH,et al.Thirty-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy[J].J Neurosurg,2013,118(6):1329-1335.

[8] 王忠诚,只达石,凌锋,等.中国颅脑创伤外科手术指南[A].中国医师协会神经外科医师分会第四届全国代表大会论文集[C] ,2009:467-469.

[9] 江基尧.介绍一种美国临床常用的标准外伤大骨瓣开颅术[J].中华神经外科杂志,1998,14(6):381.

[10] Yang C,Li Q,Wu C,et al.Surgical treatment of traumatic multiple intracranial hematomas[J].Neurosciences(Riyadh),2014,19(4):306-311.

[11] Maas AI,Steyerberg EW,Butcher I,et al.Prognostic value of computerized tomography scan characteristics in traumatic brain injury:results from the IMPACT study[J].J Neurotrauma,2007,24(2):303-314.

[12] Vigué B.Update on medical management of severe head trauma[J].Neurochirurgie,2003,49(6):583-594.

[13] Lü LQ,Jiang JY,Yu MK,et al.Standard large trauma craniotomy for severe traumatic brain injury[J].Zhonghua Chuang Shang Za Zhi,2003,6(5):302-304.

[14] Huang Q,Dai WM,Wu TH,et al.Comparison of standard large trauma craniotomy with routine craniotormy in treatment of acute subdural hematoma[J].Zhonghua Chuang Shang Za Zhi,2003,6(5):305-308.

[15] Motohashi O,Kameyama M,Kon H,et al.Two cases of impending herniation due to multiple traumatic acute subdural hematomas:combination of burr hole evacuation and craniotomy[J].No Shinkei Geka,2003,31(5):529-535.

[16] 李新,范颖.析因设计重复测量资料的统计分析及SPSS实现[J].数理医药学杂志,2013,26(4):400-402.

[17] 范引光,张文慧,陈国平.统计分析中检验方法的选择[J].疾病控制杂志,2008,12(2):146.

[18] 霍春慧,李丽群,张毅华,等.显微镜下颅内动脉瘤夹闭术的术中配合与护理[J].长春中医药大学学报,2015,31(4):836-838.

标准外伤大骨瓣减压术对外伤性多发性颅内血肿患者术后意识障碍恢复的影响

Influence of standard trauma craniectomy in conscious disturbance recovery in patients with traumatic multiple intracranial hematoma

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

Metrics

本文评价

推荐阅读 0