早期颅骨修补对颅脑损伤去骨瓣减压术后患者预后的影响Effect of early cranioplasty for prognosis in craniocerebral injury patients after decompressive craniectomy
邵东传;赵楠;李进;吴钧;刘俊;普快荣;陈曦;杨洲;马钢;
摘要(Abstract):
目的探讨早期颅骨修补对创伤性颅脑损伤去骨瓣减压术后患者日常生活能力和神经功能的影响。方法选取昆明市第一人民医院神经外科2016-01—2019-10收治的121例创伤性颅脑损伤去骨瓣减压术后患者为研究对象,根据颅骨修补的时机,将其分成早期组(术后≤3个月,50例)与晚期组(术后>3个月,71例)。比较2组患者术前、术后6个月功能独立性评定量表(FIM)评分、简明精神状态量表(MMSE)评分,同时比较术后并发症发生率、住院时间、术中失血量。结果早期组术后FIM评分、MMSE评分[120.0(115.0,124.2)分和27.0(24.5,29.0)分]较术前[114.0(90.0,116.5)分和23.0(15.8,25.3)分]均有所提高,同时晚期组术后FIM评分、MMSE评分[117.0(110.0,120.0)分和26.0(18.0,27.0)分]较术前[115.0(105.0,119.0)分和24.0(16.0,26.0)分]均有提高,差异具有统计学意义(均P<0.05)。术后早期组FIM评分、MMSE评分[120.0(115.0,124.2)分和27.0(24.5,29.0)分]较晚期组[117.0(110.0,120.0)分和26.0(18.0,27.0)分]提高更明显,差异具有统计学意义(均P<0.05);本组无死亡和感染病例,早期组和晚期组硬膜外血肿和积液发生率[8%(4/50)和9.9%(7/71)],癫痫发生率[10%(5/50)和19.7%(14/71)],脑积水的发病率[4%(2/50),2.8%(2/71)],术后住院时间[(8(7,9)d和8(7,9)d]和术中失血量[300(300,400)mL和300(250,350)mL]差异均无统计学意义(均P>0.05)。结论早期颅骨修补(≤3个月)并未增加术后并发症的发生率和住院时间及术中失血量,且更有助于日常生活能力的改善和神经功能的恢复。
关键词(KeyWords): 颅脑损伤;去骨瓣减压;颅骨修补;早期;预后
基金项目(Foundation): 云南省卫生科技计划项目(编号:2018NS0168)
作者(Authors): 邵东传;赵楠;李进;吴钧;刘俊;普快荣;陈曦;杨洲;马钢;
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