大骨瓣减压对不同年龄重型颅脑创伤患者脑血流量及脑代谢的影响  

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

作　　者：徐震[1] 黄李法[1] 吕晓皑[2] 王翼伟[3] 张昕[1] 竺国充[1] 李徐[1] 

机构地区：[1]浙江中医药大学附属第一医院神经外科,杭州310006 [2]浙江中医药大学附属第一医院外科,杭州310006 [3]河北大学附属医院神经外科

出　　处：《中华神经外科杂志》2011年第1期62-64,共3页Chinese Journal of Neurosurgery

摘　　要：目的 探讨大骨瓣减压对不同年龄重型颅脑创伤患者脑血流量及脑代谢的影响.方法 将71例重型颅脑创伤患者分为＜30岁组、30～50岁组和＞50岁组.每组又分为治疗组和对照组,大骨瓣减压手术前后行桡动脉和颈内静脉血气分析及血糖、血乳酸、血红蛋白监测,计算动脉-颈内静脉血糖差、颈内静脉-动脉乳酸差以及脑氧摄取率,TCD测定脑血流量.结果 术后第1天开始,≤50岁治疗组患者的脑血流量和脑氧摄取率均明显大于对照组;＞50岁治疗组患者的脑血流量明显高于对照组,脑氧摄取率明显低于对照组（P＜0.05）.术后第3天开始,≤50岁治疗组患者的动脉-颈内静脉血糖差明显高于对照组,颈内静脉-动脉乳酸差明显低于对照组;＞50岁治疗组患者的动脉-颈内静脉血糖差明显低于对照组（P＜0.05）,颈内静脉-动脉乳酸差明显高于对照组（P＜0.05）.结论 大骨瓣减压能增加50岁以下重型颅脑创伤患者的脑血流量和脑氧代谢,能增加50岁以上患者的脑血流量并降低脑氧代谢.Objective To explore the effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury.Method 71 cases were divided into three groups according age：group A（ ＜30 years） ,group B（30 ～50 years） ,group C （ ＞ 50 years）.Each group was divided into decompressive craniectomy （ DC ） treatment group and control group.Monitor dynamically blood gas analysis, glucose, lactic acid, hemoglobin in radial artery and internal jugular venous bulb, accounting the cerebral oxygen extraction （ CEO2 ） and the D - values of glucose and lactic acid respectively between radial artery and internal jugular venous bulb.Color doppler ultrasonography was used to determine the cerebral blood flow volume（CBFV）.Results From the 1 st to 7th day, the CBFV and CEO2 of DC group were significantly greater than control group in group A and group B.The CBFV was significantly greater than control group while the CEO2 was lower than control group in group C （ P ＜ 0.05 ）.From third day, the D - values of glucose of DC group was significantly higher than control group while the D - values of lactic acid was lower than control group in group A and group B, the D - values of glucose of DC group was significantly lower than control group while the D - values of lactic acid was higher than control group in group C（ P ＜ 0.05 ）.Conclusions Decompression craniectomy can increase the CBFV and brain oxygen metabolism in STBI patients before age 50 and increase the CBFV in patients after age 50 whereas decrease the brain oxygeon metabolism.

关 键 词：大骨瓣减压 颅脑损伤 脑血流量 脑代谢 脑氧摄取率 

分 类 号：R651.15[医药卫生—外科学]