颅骨缺损合并慢性脑积水致脑膨出同期手术前后颅内压及脑血流的变化  

Changes of intracranial pressure and cerebral blood flow before and after one-stage ventriculo-peritoneal shunt and cranioplasty in patients with encephalocele induced by cranial defect combined with primary hydrocephalus

作　　者：王占君[1] 李国京[1] 吴春玲[1] 王志峰[1] 李金恒[1] 

机构地区：[1]河北省沧州市中心医院西院区脑科医院神经外一科,061001

出　　处：《检验医学与临床》2014年第23期3289-3291,共3页Laboratory Medicine and Clinic

摘　　要：目的分析颅骨缺损合并慢性脑积水致脑膨出的患者在行同期颅骨修补及脑室-腹腔分流术时,手术前、后的脑室压力及脑血流速度的变化情况,从而为制定合理的临床治疗策略提供依据,指导临床个体化治疗。方法选取2007年1月至2013年1月沧州市中心医院收治的因外伤原因行去骨瓣减压术后并发慢性脑积水导致局部脑膨出的患者106例,术前及术后行腰穿测定脑脊液压力,测量术前骨窗膨出高度;检测脑血流相关参数,分析患者颅骨修补前、后颅内压的变化情况和左、右侧的颈内动脉终末段、大脑前动脉、大脑中动脉以及基底动脉血流速度的变化。结果术前骨窗膨出超过3cm的患者同期行颅骨修补及脑室-腹腔分流术,术后脑脊液压力明显升高,而膨出低于3cm的患者术前术后脑脊液压力变化不大;手术前后脑血流速度比较,差异无统计学意义(P>0.05)。结论术前颅骨膨出程度与术后颅内压升高相关,以术前骨窗膨出3cm为临界值,对临床分流管的选择具有指导意义;还应结合脑血流速度以外的其他指标对脑血供的改善进行评价。Objective To analyze changes in intracranial pressure and cerebral blood flow before and after one‐stage ventriculo‐peritoneal shunt and cranioplasty in patients with encephalocele induced by cranial defect combined with primary hydrocephalus ,in order to provide a basis for rational therapy and guide the individualized therapy. Methods A total of 106 patients with encephalocele induced by primary hydrocephalus after decompressive craniec‐tomy ,treated in this hospital from Jan. 2007 to Jan. 2013 ,were enrolled in this study. Cerebrospinal fluid pressure was detected by lumbar puncture before and after one‐stage operation ,and the height of bone window bulging was meas‐ured as well. Parameters related to cerebral blood flow were detected. Changes in intracranial pressure and blood flow velocity of the end of internal carotid artery（ICA） on the left and right side ,anterior cerebral artery（ACA） ,middle cerebral artery（MCA ）and basilar artery before and after one‐stage operation were analyzed. Results In patients whose height of bone window bulging was more than 3 cm ,after one‐stage operation the intracranial pressure was ob‐viously increased;in patients whose height of bone window building was less than 3 cm ,after one‐stage operation the intracranial pressure changed slightly. There was no significant difference of blood flow velocity between that of be‐fore and after one‐stage operation（P＆gt;0. 05）. Conclusion The degree of preoperative bone window bulging could be related to the increase of postoperative intracranial pressure ,and setting 3 cm as a critical value could be benefit for the selection of bypass tube. Except for blood flow velocity ,it might be necessary to combing other indicators to eval‐uate the improvement of cerebral blood supply.

关 键 词：脑积水 脑室-腹腔分流术 颅骨缺损 

分 类 号：R683.5[医药卫生—骨科学]