控制性减压术与标准大骨瓣减压术治疗老年重型颅脑损伤并发脑梗死[摘要]目的探?控制性减压术与标准大骨瓣减压术治疗老年重型颅脑损伤并发脑梗死的效果比较情况。方法分析我院2010年1月～2016年10月收治的72例患者临床资料，依据手术方式不同分为控制性减压术组36例和标准大骨瓣减压术组36例。观察两组患者术前、术中、术毕及术后6个月的颅内压情况，观察两组患者术后6个月神经行为状况测试（NCSE）评分、Barthel指数和格拉斯哥预后评分（GOS）评分情况，观察两组患者预后良好率情况。结果两组患者术前颅内压差异无统计学意义（P>0.05），控制性减压术组术中、术毕及术后6个月的颅内压均低于标准大骨瓣减压术组，控制性减压术组术后6个月NCSE评分、Barthel指数和GOS评分均高于标准大骨瓣减压术组，控制性减压术组患者预后良好率高于标准大骨瓣减压术组，差异均有统计学意义（P<0.05）。结论控制性减压术治疗老年重型颅脑损伤并发脑梗死患者，术后颅内压改善效果明显，预后良好，值得临床推广应用。[关键词]控制性减压术；标准大骨瓣减压术；老年重型颅脑损伤；脑梗死；比较[]R651.1[文献标识码]A[]1674-4721（2017）11（a）-0061-04EffectcomparisonofcontrolleddecompressionandstandardlargedecompressivecraniectomyinthetreatmentofsenileseverecraniocerebralinjurycomplicatedwithcerebralinfarctionXUXinCHENXiao-pingDepartmentofNeurosurgery，theSecondPeople′sHospitalofPingxiangCity，激angxiProvince，Pingxiang337000，China[Abstract]ObjectiveToexploretheeffectcomparisonofcontrolleddecompressionandstandardlargedecompressivecraniectomyinthetreatmentofseverecraniocerebralinjurycomplicatedwithcerebralinfarctionintheelderly.MethodsTheclinicaldataof72patientstreatedinourhospitalfromJanuary2010toOctober2016wereanalyzed.Accordingtothedifferentsurgicalmethods，theywereevenlydividedintocontrolleddecompressiongroupandstandardlargedecompressivecraniectomygroup，36casesineachgroup.Theconditionsofintracranialpressurebefore，during，justafter，and6-monthaftersurgerieswereobservedinthetwogroups.TheNCSEscore，BarthelindexandGOSscoreofthetwogroupswereobserved6monthsafteroperation.Thefavorablerateforprognosisinthetwogroupswasalsoobserved.ResultsBeforesurgery，therewasnosignificantdifferenceintheintracranialpressurebetweenthetwogroups.During，justafter，and6-monthafteroperation，theintracranialpressureofthetwogroupswaslowerthanthatinthestandardlargedecompressivecraniectomy.Inthecontrolleddecompression，theNCSEscore，Barthelindex，andGOSscorewereallhigherthanthoseinthestandardlargedecompressivecraniectomygroup6monthsafteroperation.Thefavorablerateforprognosisinthecontrolleddecompressiongroupwasbetterthaninthethatofstandardlargedecompressivecraniectomygroup，withastatisticaldifference（P<0.05）.ConclusionControlleddecompressioniseffectiveinthetreatmentofseverecraniocerebralinjurycomplicatedwithcerebralinfarctionintheelderlywithremarkableimprovementofintracranialpressureandfavorablerateforprognosis，whichisworthyofclinicalapplicationandpromotion.[Keywords]Controlleddecompression；Standardlargedecompressivecraniectomy；Elderlyseverecraniocerebralinjury；Cerebralinfarction；Comparison重型颅脑损伤属于脑外科常见的损伤，主要是由于高能量创伤引起的，颅内血肿形成后，对周围脑组织造成积压，颅脑损伤后脑水肿进一步加重，颅内压力不断升高，进而造成继发性的脑损伤，血肿还会造成脑室受压变形，中线发生偏移，严重者形成脑疝，甚至可能造成死亡[1-2]。手术治疗是临床常用的方法，通过减压性手术降低患者颅内压，但是一些重型颅脑损伤患者仍然可能并发脑梗死，因而在减压治疗过程中要注意防止继发性脑梗死[3-4]。常用的减压术主要包...