摘要：

目的: 探讨颅脑创伤并脑出血患者控制性减压联合开颅血肿清除术的疗效。方法: 纳入2023年1月至2024年10月广西壮族自治区来宾市人民医院收治的60例颅脑创伤并脑出血患者，分别予以颅内压监测下控制性减压联合开颅血肿清除术（颅内压监测组，32例）和传统开颅血肿清除术联合去骨瓣减压术（对照组，28例），记录术中骨瓣回纳率，围手术期再出血、头皮渗液、颅内感染、脑梗死发生率和术后再次手术率，伤后6个月采用Glasgow预后分级（GOS）评估患者预后。结果: 共60例患者中40例（66.67%）伤后6个月预后良好（GOS评分4 ~ 5分），20例（33.33%）预后不良（GOS评分1 ~ 3分）。颅内压监测组患者术中骨瓣回纳率（χ² = 10.000，P = 0.002）和伤后6个月GOS评分（Z = -3.206，P = 0.001）高于对照组，围手术期头皮渗液（校正χ² = 3.871，P = 0.049）和颅内感染（Fisher确切概率法：P = 0.020）发生率低于对照组。结论: 与传统开颅血肿清除术联合去骨瓣减压术相比，控制性减压联合开颅血肿清除术可以增加颅脑创伤并脑出血患者术中骨瓣回纳率，降低围手术期头皮渗液、颅内感染等并发症风险，并改善患者预后。

关键词: 脑损伤，创伤性, 脑出血, 颅内压, 颅骨切开术, 血肿, 预后

Abstract:

Objective: To evaluate the clinical efficacy of controlled decompression combined with craniotomy in the treatment of intracerebral hemorrhage after traumatic brain injury (TBI). Methods: The study was conducted involving 60 patients with intracerebral hemorrhage after TBI admitted to The People's Hospital of Laibin from January 2023 to October 2024. All patients underwent controlled decompression combined with craniotomy under intracranial pressure (ICP) monitoring (ICP monitoring group, n = 32) and traditional craniotomy combined with decompressive craniectomy (control group, n = 28). The intraoperative bone flap replacement rate, perioperative period rebleeding, scalp exudate, intracranial infection, cerebral infarction incidence, and postoperative reoperation rate were recorded. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis at 6 months after TBI. Results: Among the 60 patients, 40 (66.67%) achieved a favorable outcome (GOS score of 4-5), while 20 (33.33%) had an unfavorable outcome (GOS score of 1-3) at 6 months after TBI. Compared with the control group, the ICP monitoring group exhibited a significantly higher intraoperative bone flap replacement rate (χ² = 10.000, P = 0.002) and higher GOS score at 6 months after TBI (Z = -3.206, P = 0.001). Additionally, the incidences of perioperative period scalp exudate (adjusted χ² = 3.871, P = 0.049) and intracranial infection (Fisher's exact probability: P = 0.020) were significantly lower in the ICP monitoring group than those in the control group. Conclusions: Compared with traditional craniotomy combined with decompressive craniectomy, controlled decompression combined with craniotomy can increase the intraoperative bone flap replacement rate, reduce the risk of perioperative period complications such as scalp exudate and intracranial infection, and improve prognosis in patients with intracerebral hemorrhage after TBI.

Key words: Brain injuries, traumatic, Cerebral hemorrhage, Intracranial pressure, Craniotomy, Hematoma, Prognosis