去骨瓣减压术联合同侧脑室外引流术治疗重型创伤性脑损伤的疗效·颅脑损伤·去骨瓣减压术联合同侧脑室外引流术治疗重型创伤性脑损伤的疗效李少阳1牟朝晖1陈敏江1黄至澄1李兴1沈国良1吴剑1李春茂11台州市第一人民医院神经外科318020通信作者:李春茂,Email:lichum@163.,电话:0576-84122622【摘要】目的探讨联合去骨瓣减压术(DC)和同侧脑室外引流术(iEVD)治疗重型创伤性脑损伤(sTBI)的疗效。方法采用回顾性病例对照研究分析xx年1月—2018年3月台州市第一人民医院神经外科收治的54例sTBI患者临床资料,其中男36例,女18例:年龄18~72岁[(51.8±15.4)岁]。格拉斯哥昏迷评分(GCS)3~8分。27例采用DC治疗(DC组),其中男18例,女9例;年龄(50.1±2.9)岁。27例采用DC联合iEVD治疗(DC-iEVD组),其中男18例,女9例;年龄(53.4±3.1)岁。比较两组术后颅内压、术后2周并发症,采用改良的Rankin量表(mRS)评估术后3个月患者预后。结果患者均获随访2.5~4个月[(3.0±0.8)个月]。术后12,24h两组颅内压差异无统计学意义(P>0.05),术后36,48,60,72hDC-iEVD组颅内压值低于DC组(P<0.05)。术后2周DC-iEVD组脑积水发生率为15%(4/27),DC组发生率为7%(2/27),差异无统计学意义(P>0.05)。术后2周DC-iEVD组硬膜下积液发生率为19%(5/27),小于DC组的44%(12/27)(P<0.05)。根据mRS,术后3个月DC-iEVD组预后良好率为63%(17/27),而DC组为44%(12/27),DC-iEVD组预后略优于DC组,但差异无统计学意义(P>0.05)。结论对于sTBI患者,联合使用DC和iEVD,可更好地控制颅内压,减少硬膜下积液的发生。【关键词】脑损伤;减压颅骨切除术;引流术;硬膜下积液;脑积水DOI:10.3760/cma.j.issn.1001-8050.2019.03.007EfficacyofdepressivecraniectomybinedwithipsilateralexternalventriculardrainageforseveretraumaticbraininjuryLiShaoyang1,MouZhaohui1,ChenMinjiang1,HuangZhicheng1,LiXing1,ShenGuoliang1,WuJian1,LiChunmao11DepartmentofNeurosurgery,FirstPeople’sHospitalofTaizhou,Taizhou318020,ChinaCorrespondingauthor:LiChunmao,Email:lichum@163.,Tel:0086-576-84122622【Abstract】ObjectiveToinvestigatetheefficacyofdepressivecraniectomy(DC)binedwithipsilateralexternalventriculardrainage(iEVD)forseveretraumaticbraininjury(sTBI).MethodsAretrospectivecasecontrolstudywasperformedontheclinicaldataof54sTBIpatientsadmittedtotheFirstPeople’sHospitalofTaizhoufromJanuaryxxtoMarch2018.Therewere38malesand18females,aged18-72years[(51.8±15.4)years].TheGlasgowComaScale(GCS)ofpatientsrangedfrom3to8points.Among54patients,27receivedDCtreatment,including18malesandninefemalesaged(50.1±2.9)years(DCgroup);27patientsreceivedDCbinedwithiEVD,including18malesandninefemalesaged(53.4±3.1)years(DC-iEVDgroup).Intracranialpressureaftersurgeryandplications(hydrocephalusandsubduralhygroma)2weeksaftersurgery,andModifiedRankinScale(mRS)3monthsaftersurgerywereparedbetweenthetwogroups.ResultsAllpatientswerefollowedupfor2.5-4months[(3.0±0.8)months].Nosignificantdifferencewasfoundinintracranialpressureatpostoperative12hoursand24hoursbetweenthetwogroups(P>0.05).However,theintracranialpressureofDC-iEVDgroupweresignificantlylowerthanthoseofDCgroupat36,48,60and72hoursafteroperation(P<0.05).Thehydrocephalusincidence2weeksaftersurgeryofDC-iEVDgroupwas·122·中华创伤杂志2019年3月第35卷第3期ChinJTrauma,March2019,Vol.35,No.3万方数据15%(4/27),whilethatofDCgroupwas7%(2/27)(P>0.05).Thesubduraleffusionincidence2weeksaftersurgeryofDC-iEVDgroupwas19%(5/27),whilethatofDCgroupwas44%(12/27)(P<0.05).AordingtomRS,patientswithgoodouteinDC-iEVDgroupaountedfor63%(17/27)whiletheratiowas44%(12/27)inDCgroup.TheprognosisofDC-iEVDgroupwasslightlybetterthanthatofDCgroup,butthedifferencewasnotstatisticallysignificant(P>0.05).ConclusionForsTBI,bi...