重型颅脑外伤术后脑梗塞预防性治疗研究  

Postoperative prophylactic treatment of cerebral infarction after operation of severe craniocerebral injury

作　　者：张志强[1] 陈红庆[1] 程新富[1] 谭宗德[1] 

机构地区：[1]中国人民解放军第161中心医院神经外科,武汉430010

出　　处：《临床急诊杂志》2009年第5期285-287,共3页Journal of Clinical Emergency

摘　　要：目的:探讨重型颅脑外伤患者早期术后治疗对脑梗死发生的影响。方法:重型颅脑外伤共133例,均采用常规去骨瓣开颅术清除血肿减压,根据术后急性期(3d)内收缩压状况分为A、B、C3组(<150mmHg,151～180mmHg,>180mmHg),术后行脱水及扩血管治疗。术后1、3、7d复查CT。结果:本研究病例共出现49例脑梗死,A、B、C3组分别为20、17、12例,其中死亡9例,A、C组分别为7例、2例。结论:收缩压过高或过低是重型路脑外伤患者术后脑梗塞发生及其预后的重要因素,术后急性期内维持收缩压于稍高状态(151～180mm-Hg)可有效减少患者脑梗死发生率,降低病死率。Objective：To investigate the effects of early postoperative treatment on cerebral infarction occurred in patients with severe craniocerebral injury after operation. Method： 133 cases of severe craniocerebral injury were admitted in our study. All of them were treated by ordinary decoropressive craniotomies to evacuate hematoma. The patients were divided into 3 groups （ A, B, C） according to their systolic blood pressure （SBP） levels （ 〈 150 mmHg, 151 - 180 mmHg, 〉 180 mmHg） in acute stage （ 3 days）, and the dehydrating agents, vasodilators treated after operation. All cases were given CT scanning at 1 day,3day and 7day after surgery separately. Result：49 patients presented with cerebral infarction. There were 20,17 and 12 cases in group A,B and C separately. Of them 9 cases died. There were 7 and 2 cases in group A and C separately. Conclusion： Excessive high or low level of SBP plays a certain role in the pathogenesis and prognosis of postoperative cerebral infarction for patients with severe craniocerebral injury. To maintain SBP at a little higher state （ 151 - 180 mmHg） in acute stage is an effective method for reducing the rate of cerebral infarction, which can also decrease the mortality rate effectively.

关 键 词：颅骨切开术 收缩压 脑梗塞 

分 类 号：R651.1[医药卫生—外科学]