目的 探讨双侧额叶脑挫裂伤开颅手术时机及颅内压监测的临床应用价值。方法 回顾性分析2005年至2010年,66例双侧额叶脑挫裂伤并接受冠状切口双额去骨瓣减压术的病例,手术结合颅内压监测治疗的35例患者为监测组,仅手术未采用颅内压监测治疗的31例患者为对照组。比较两组患者术后12个月的临床疗效,并总结双侧额叶脑挫裂伤的临床变化特点、手术时机、颅内压监测的临床应用价值及疗效。结果 66例患者中18例急诊手术,48例入院时不具备手术指征,病情逐渐加重而采用手术治疗。随访12个月,按GOS评分评定预后,监测组3例死亡,1例植物生存,2例重残,4例中残,25例良好。对照组5例死亡,2例植物生存,2例重残,6例中残,16例良好。监测组与对照组预后恢复良好率分别为71.43%和51.61%(P＜0.05)。结论 双侧额叶脑挫裂伤在保守治疗过程中有较大比例需进行手术,应严密观察病情变化,把握合理手术时机,冠状切口双额去骨瓣减压术是一种有效的手术方式。应用颅内压监测能动态地了解颅内压力变化情况,为临床上及时处理颅内高压提供客观准确的依据,为改善患者预后起到了积极的作用。
Objective To explore the operation time and application value of intracranial pressure monitoring in treatment of patients with bifrontal lobe of brain contusion and laceration.Methods Clinical data of 66 patients with bifrontal lobe of brain contusion and laceration from 2005 to 2010 were studied retrospectively.66 patients were underwent bifrontal decompressive craniectomy.35 cases treated by bifrontal decompressive craniectomy combined with intracranialpressure monitoring were included in monitoring group.31 cases treated only by bifrontal decompressive craniectomy were included in control group.The clinical efficacy of both two groups were compared 12 months later.The data were retrospectively analyzed in order to summary the clinical characteristics,operational time,application value of intracranial pressure monitoring and prognosis.Results 8 cases got emergence operation,58 cases were operated during the medical treatment because their situation developed worse gradually.All of the patients were followed up for twelve months.According to GOS assessment,there are 3 cases died,1 case with persistent vegetative state,2 cases with severe disability,4 cases with moderate disability,25 cases got good recovery in monitoring group.There are 5 cases of dearh,2 case with persistent vegetative state,2 cases with severe disability,6 cases with moderate disability,16 cases got good recovery in control group.The favorable prognosis rate of monitoring group and control group was 71.43% and 51.61%(P＜0.05).Conclusion The situation of many patients with bifrontal lobes brain contusion and laceration will become worse and worse gradually.The doctors should observe the patients carefully and operate on them in time.The bifrontal decompressive craniectomy is an effective method for the surgical management.The intracranial pressure monitoring can dynamically observe ICP,providing the objective and accurate evidence,and improve the prognosis of patients.
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