去骨瓣减压联合着力部位硬膜外血肿清除治疗对冲性重症颅脑损伤的效果观察OA

Objective:To observe the clinical effect of decompressive craniectomy combined with evacuation of epidural hematoma at the focus area in the treatment of contrecoup severe traumatic brain injury.Method:A total of 216 patients with contrecoup severe traumatic brain injury treated in Fuqing City Hospital,Fujian Province from January 2020 to February 2023 were selected and divided into study group and control group according to random number table method,with 108 cases in each group.The control group was treated with decompressive craniectomy combined with conventional craniotomy evacuation of hematoma,and the study group was treated with decompressive craniectomy combined with evacuation of epidural hematoma at the focus area.The clinical symptoms,prognosis,conscious state,postoperative complications and traumatic stress reaction were compared between the two groups.Result:The good prognosis rate and Glasgow coma scale(GCS)scores at 7 days after surgery in the study group were higher than those in the control group,the hematoma thickness and midline displacement at 7 days after surgery were lower than those in the control group,the intracranial pressure at 7 days after surgery,the incidence of postoperative complications,and the levels of adrenaline(E),β-endorphin(β-EP)and cortisol(Cor)at 7 days after surgery were lower than those of control group(P<0.05).Conclusion:Decompressive craniectomy combined with evacuation of epidural hematoma at the focus area has a significant effect in the treatment of contrecoup severe traumatic brain injury,which can not only remove cerebral hematoma,reduce intracranial pressure,relieve midline displacement and traumatic stress,but also improve patients'conscious state,reduce postoperative complications,and improve prognosis.