Abstract：Objective To investigate the clinical effect of step-by-step controlled decompression in the treatment of severe traumatic brain injury. Methods A total of 140 patients with severe traumatic brain injury admitted into the Affiliated Hospital of Xiangnan University from January 2019 to December 2020 were selected as the research subjects.They were divided into a control group and an observation group by random number table method，70 cases in each group. The patients in the control group were treated with craniotomy hematoma removal and bone flap decompression，and patients in the observation group were treated with step-by-step controlled decompression. The improvement of daily living ability，the total incidence of adverse reactions and the recovery of neurological function were compared between the two groups. Results There were no significant differences in intraoperative blood loss，postoperative hospital stay and operation time between the two groups (P＞0.05). Before treatment，there were no significant differences in the scores of independent living ability between the two groups (P＞0.05). The scores of eating，toilet，flat walking，bed and chair transfer and other independent living ability and total scores of patients in the observation group were higher than those in the control group after treatment，with statistically significant differences (P＜0.05). The total incidence of complications in the observation group was lower than that in the control group，the difference was statistically significant(P＜0.05). Before treatment，there were no significant differences in National Institutes of Health stroke scale (NIHSS)score and Barthel index of activities of daily living between the two groups (P＞0.05). NIHSS score of observation group was lower than that in the control group after treatment，the difference was statistically significant (P＜0.05). The Barthel index of the observation group was higher than that of the control group after treatment，the difference was statistically significant (P＜0.05). Conclusion The application of step-by-step controlled decompression in the treatment of severe traumatic brain injury can significantly improve the patients′ daily autonomous living ability after surgery，restore patients′ neurological function，and reduce the occurrence of adverse reactions.
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