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目的观察标准大骨瓣开颅血肿清除对重度颅脑外伤侧裂区损伤致单侧脑肿胀的疗效。方法 80例重度颅脑外伤侧裂区损伤致单侧脑肿胀患者,采用随机单盲法分为对照组和观察组,各40例。对照组患者实施常规大骨瓣开颅血肿清除术治疗,观察组患者采用标准大骨瓣开颅血肿清除术治疗,比较两组患者的治疗效果。结果术后7 d,观察组的脑水肿和中线移位低于对照组,格拉斯哥昏迷量表(GCS)评分高于对照组,差异均具有统计学意义(P<0.05)。术后随访1年,观察组中13例恢复良好,9例中度残疾,6例重度残疾,2例植物生存,10例死亡,生存率为75.0%;对照组中8例恢复良好,4例中度残疾,4例重度残疾,3例植物生存,21例死亡,生存率为47.5%;观察组生存率明显高于对照组,差异具有统计学意义(χ~2=6.373,P<0.05)。结论应用标准大骨瓣开颅血肿清除术治疗重度颅脑外伤侧裂区损伤致单侧脑肿胀的效果好,可有效改善患者的预后,提高患者的生存率,值得临床推广。
Objective To observe the curative effect of standard craniotomy hematoma removal on unilateral brain swelling caused by severe traumatic brain injury. Methods Eighty patients with severe bilateral traumatic brain injury caused by unilateral brain swelling were randomly divided into control group and observation group with 40 cases in each group. Patients in the control group were treated with conventional craniotomy for large bone flap craniotomy. Patients in the observation group were treated with standard craniotomy for large craniotomy, and the therapeutic effect was compared between the two groups. Results At 7 days after operation, the edema and midline displacement of the observation group were lower than those of the control group. The GCS score of the observation group was higher than that of the control group (P <0.05). After one year of follow-up, 13 cases in the observation group recovered well, 9 were moderately disabled, 6 were severely disabled, 2 were vegetative and 10 died. The survival rate was 75.0%. In the control group, 8 patients recovered well and 4 patients Moderate disability, 4 cases of severe disability, 3 cases of plant survival and 21 cases of death. The survival rate was 47.5%. The survival rate of the observation group was significantly higher than that of the control group (χ ~ 2 = 6.373, P <0.05) . Conclusion The treatment of severe craniofacial hematoma by large craniotomy for the treatment of severe craniocerebral injury caused by unilateral brain swelling has a good effect, which can effectively improve the prognosis and improve the survival rate of patients. It is worthy of clinical promotion.