术前急诊钻颅引流对重型颅脑创伤脑疝患者颅内压、脑组织氧分压及其预后的影响研究  

The effect of emergent pre-operarative skull drilling drainage on severe traumatic cerebral hernia's intracranial pressure,brain tissue partial pressure of oxygen and its prognosis

作　　者：方乃成 邵高峰 何玉领 杜国森 赵明 陈江利 陈飞 金星火 杨刚 王马军 

机构地区：[1]诸暨市人民医院神经外科,浙江省诸暨311800

出　　处：《中国基层医药》2006年第2期179-181,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的监测钻颅引流前后颅内压(ICP)、脑组织氧分压(PbtO2),探讨术前急诊钻颅引流在重型颅脑创伤脑疝患者中应用的临床价值。方法按脑创伤脑疝类型分为单瞳散大组42例,双瞳散大组34例,均在开颅前行急诊钻颅引流术,并同时在非损伤侧额叶脑组织内先置入ICP、PbtO2探头,连续监测并记录钻颅引流前后的ICP、PbtO2。结果钻颅引流能降低ICP,提高PbtO2,两组与术前比较差异均有非常显著意义(P<0.001)。治疗结果:良好/中残,单瞳散大组36例(78.57%),双瞳散大组16例(44.12%);重残/长期昏迷:单瞳散大组1例(7.14%),双瞳散大组8例(26.47%);死亡:单瞳散大组7例(14.29%),双瞳散大组15例(44.12%)。结论术前急诊钻颅引流术能有效降低ICP和提高PbtO2,改善脑疝症状,缩短脑疝时限,延长脑创伤脑疝患者的手术治疗时间窗,对于提高重型颅脑创伤脑疝患者的治愈率,降低死亡率和致残率,具有较高的临床应用价值。Objective Monitoring intracranial pressure（ICP）, brain tissue partial pressure of oxygen（PbtO2 ） before and after skull drilling drainage to provide theoretical base for the use of emergent pre-operative skull drilling drainage in severe traumatic cerebral hernia patients. Methods According to the type of traumatic cerebral hernia, the patients were grouped as group Ⅰ ： single pupil enlarged, with 42 cases, and group Ⅱ ： bilateral pupil enlarged, with 39 cases. Emergent pre-operative skull drilling drainage were done in both groups to shorten the time of cerebral hernia. ICP,PbtO2 probe was lagged in the same time into the non-injured frontal lobe. The data of ICP,PbtO2 before and after drainage were monitered and recorded. The data were statistically analyzed. Results Skull drilling drainage can decrease ICP and increased PbtO2. There are significant differences（ P 〈 0. 001 ） in two groups. Treatment result： good/moderate disability：group Ⅰ36 cases（78.57 % ） ,group Ⅱ 16 cases（44.12 % ） ;Severe disability/long-term co- ma：group Ⅰ 1 case（ 7.14 % ） , group Ⅱ 8 cases（26.47%）;Death：groupⅠ 7 cases（14.29%）,group Ⅱ 15 cases （44.12 % ）. Conclusion Clinical prospective study proved that emergent skull drilling drainage can derease ICP and increase PbtO2 effectively, ameliorate the cerebral hernia＇ s symptoms, shorten the term, prolong the operative therapic window time, so it will increase the severe traumatic cerebral cerebral hernia patients＇ s cure rate, decrease the death rate and disability rate,and has an important clinical value.

关 键 词：脑损伤 脑疝 钻颅引流 颅内压 脑组织氧分压 

分 类 号：R651.1[医药卫生—外科学]