减压性颅骨切除术对创伤性重型颅脑损伤患者脑血流灌注的影响  

Effect of decompressive craniectomy on cerebral blood flow in patients with severe traumatic brain injury

作　　者：安剑铮 汪友平 童涛 曹国彬[4] 曾思铭[4] An Jianzheng;Wang Youping;Tong Tao;Cao Guobin;Zeng Siming(Department of Neurosurgery,the Second Affiliated Hospital of Guangdong Pharmaceutical University (Guangzhou Xinhai Hospital),Guangzhou 510300,China;Department of Emergency,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Radiology,the Second Affiliated Hospital of Guangdong Pharmaceutical University (Guangzhou Xinhai Hospital),Guangzhou 510300,China;Department of Neurosurgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广东药学院附属第二医院(广州新海医院)神经外科,广州510300 [2]广州医科大学附属第一医院急诊科,510120 [3]广东药学院附属第二医院(广州新海医院)放射科,广州510300 [4]广州医科大学附属第二医院神经外科,510260

出　　处：《中国实用医刊》2019年第1期19-22,共4页Chinese Journal of Practical Medicine

基　　金：广东省中医药局科研项目(20161145).

摘　　要：目的探讨减压性颅骨切除术(去骨瓣切除术)对创伤性脑损伤患者脑血流灌注的影响。方法选择2011年1月至2015年12月广东药学院附属第二医院和广州医科大学附属第二医院收治的创伤性重型颅脑损伤患者70例,其中40例行减压性颅骨切除术并植入颅内压监测探头的患者为观察组,30例患者家属不同意行减压性颅骨切除术但行颅骨钻孔植入颅内压监测探头监测颅内压(ICP)以指导药物治疗者为对照组。所有患者术后监测颅内压,术前及术后监测脑血流量(CBF)、脑血容量(CBV)和对比剂平均通过时间(MTT),并进行统计学分析。结果两组患者术前CBF、CBV和MTT比较,差异均未见统计学意义(P>0.05)。两组钻孔后初次测ICP比较,差异未见统计学意义(P>0.05)。治疗后,观察组ICP较同期对照组降低,差异有统计学意义(P<0.05);CBF、CBV较同期对照组增高,差异有统计学意义(P<0.05);MTT较同期对照组降低,差异有统计学意义(P<0.05)。结论减压性颅骨切除术可有效降低创伤性颅脑损伤患者的ICP,提高患者CBF和CBV,降低MTT,疗效显著,为临床治疗提供有效依据。Objective To investigate the effect of decompressive craniectomy on cerebral blood flow in patients with traumatic brain injury. Methods A total of 70 patients with severe traumatic brain injury treated from January 2011 to December 2015 in the Second Affiliated Hospital of Guangdong Pharmaceutical University and the Second Affiliated Hospital of Guangzhou Medical University were selected. Among them, 40 patients who underwent decompression craniectomy and were implanted with intracranial pressure detection probe were selected as observation group;while 30 patients experienced cranial drilling for implanting intracranial pressure (ICP) detection probe to monitor intracranial pressure for medical treatments instead of decompression craniectomy for their families’ intention, and they were selected as control group. ICP were monitored after operation, and cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were monitored before and after operation in the two groups. And these indexes were analyzed statistically. Results The CBF, CBV and MTT of the two groups had no significantly difference before operation(P>0.05). There was no significant difference in ICP immediately after drilling (P>0.05). After treatment, the ICP of observation group was significantly lower than that of control group at the same period, and the difference was statistically significant (P<0.05);CBF and CBV of observation group significantly were increased as compared with control group at the same period, and the difference was statistically significant (P<0.05). MTT of observation group was significantly reduced as compared with control group at the same period, and the difference was statistically significant (P<0.05). Conclusions The decompression of brain resection can effectively reduce ICP in patients with traumatic brain injury, and it can improve the CBF and CBV, provide an effective basis for clinical treatment.

关 键 词：减压性颅骨切除术 脑血流灌注 脑血流量 

分 类 号：R651.15[医药卫生—外科学]