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目的采用血压调控联合完全机械通气治疗重症颅脑损伤开颅术后患者,观察术后脑氧摄取率(CERO_2),随访3个月内好转率与病死率。方法选择神经外科2013年7月—2015年6月重症颅脑损伤开颅术后患者54例,采用随机数字表法分为观察组28例和对照组26例。对照组采用ICU常规治疗;观察组采用ICU常规治疗合并血压调控及完全机械通气。比较2组患者一般情况,术前、术毕即刻、24、48、72小时CERO_2变化情况,随访3个月或终点事件(死亡)情况,比较2组预后。结果 2组患者一般情况中,观察组呼吸机使用时间长于对照组,差异有统计学意义(P<0.05)。观察组术后24、48、72小时CERO_2较对照组降低,差异有统计学意义(P<0.05),提示该治疗方法对术后降低CERO_2有一定效果。观察组好转率53.57%,病死率3.57%;对照组好转率15.38%,病死率30.77%,观察组好转率高于对照组,病死率低于对照组,差异有统计学意义(P<0.05)。结论重症颅脑损伤患者开颅术后血压调控联合完全机械通气可降低CERO_2,改善患者预后。治疗过程中需要注意呼吸机相关医院感染的防治,确保治疗效果。
Objective To observe the postoperative rate of cerebral oxygen uptake (CERO_2) and the rate of improvement and mortality after 3 months follow-up by using the combination of blood pressure control and complete mechanical ventilation in patients with craniocerebral injury after severe craniocerebral injury. Methods Choosing 54 patients with craniocerebral injury after craniotomy from July 2013 to June 2015 in the department of neurosurgery, 28 patients in observation group and 26 in control group were randomly divided into observation group and control group. The control group was treated with routine ICU. The observation group was treated with ICU routine blood pressure control and complete mechanical ventilation. The general situation of the two groups were compared. The changes of CERO_2 at 24, 48, and 72 hours were observed before operation and immediately after operation. The patients were followed up for 3 months or the end point (death). The prognosis was compared between the two groups. Results In general, the duration of ventilator in the observation group was longer than that in the control group, with significant difference (P <0.05). At 24, 48 and 72 hours postoperatively, the number of CERO_2 in the observation group was lower than that in the control group (P <0.05), suggesting that this treatment method may have some effect on reducing CERO_2 postoperatively. The improvement rate of observation group was 53.57% and the mortality rate was 3.57%. The improvement rate of control group was 15.38% and the mortality rate was 30.77%. The improvement rate of observation group was higher than that of control group, the mortality was lower than that of control group (P <0.05) . Conclusion In patients with severe craniocerebral injury, craniotomial blood pressure control combined with complete mechanical ventilation may reduce CERO_2 and improve prognosis. Need to pay attention to the treatment of ventilator-related hospital infection prevention and treatment, to ensure that the treatment effect.