标准去骨瓣减压联合内减压术对大面积脑梗死患者血流动力学及预后的影响  

Hemodynamic changes and prognostic analysis of large hemispheric infarction treated with standard decompressive craniectomy combined with internal decompression

作　　者：邹敏刚 罗德芳 杨瑞金 黄伟龙 张柏林 罗书华 黄锦庆 ZOU Min-gang;LUO De-fang;YANG Rui-jin;HUANG Wei-long;ZHANG Bo-lin;LUO Shu-hua;HUANG Jin-qing(Department of Neurosurgery,Ganzhou Hospital of Nanchang University,Ganzhou 341000,China)

机构地区：[1]南昌大学附属赣州医院神经外科,341000

出　　处：《天津医药》2020年第11期1059-1064,I0001,共7页Tianjin Medical Journal

基　　金：江西省卫生计生委科技计划项目(20197374);赣州市指导性科技计划项目(GZ2018ZSF238)。

摘　　要：目的探讨标准去骨瓣减压联合内减压术治疗大面积脑梗死(LHI)患者血流动力学变化并分析其预后。方法收集2017年1月—2020年2月我院行手术治疗的LHI患者42例,依据手术方式分为2组,研究组(22例)采用标准去骨瓣减压联合内减压术,对照组(20例)采用标准去骨瓣减压术,记录并分析2组术前与术后14 d时NIHSS评分、90 d时Barthel指数及病死率;于术前及术后14 d完善CT灌注成像(CTP)检查,测定梗死核心区、健侧镜像区、梗死周围区(PIZ)的脑血流量(CBF)、脑血容量(CBV)、达峰时间(TTP)、平均通过时间(MTT)绝对值,并进行比较。结果术后2组患者NIHSS评分均低于术前,Barthel指数均高于术前(P<0.01);术后研究组NIHSS评分显著低于对照组,Barthel指数明显高于对照组(P<0.05),2组病死率差异无统计学意义(P>0.05)。术后研究组核心梗死区CBF、CBV较术前显著增加,且均高于同期对照组(P<0.01)。术后对照组PIZ区CBF较术前增加,MTT较术前缩短(P<0.05),CBV、TTP与术前比较差异无统计学意义(P>0.05)。术后研究组PIZ区CBF、CBV较术前明显增加,并均高于同期对照组(P<0.05);TTP、MTT较术前明显缩短,并均低于同期对照组(P<0.01)。术后2组健侧镜像区CBF、CBV较术前显著增加,TTP、MTT显著缩短(P<0.05),但术后各参数组间对比差异均无统计学意义(P>0.05)。结论标准去骨瓣减压联合内减压术能更大程度改善LHI患者的血流动力学,特别是提升梗死周围区的血流灌注,明显促进神经功能恢复。Objective To investigate the hemodynamic changes after standard decompressive craniectomy combined with internal decompression in the treatment of large hemispheric infarction and analyze its prognosis.Methods Forty-two patients with large hemispheric infarction who underwent surgical treatment in our hospital from January 2017 to February 2020 were collected and divided into 2 groups according to different surgical methods.The patients in the study group(n=22)were performed standard decompressive craniectomy and internal decompression,and the patients in the control group(n=20)were performed standard decompressive craniectomy.The NIHSS score before and 14 days after operation,Barthel Index and fatality rate at 90d were analyzed in the two groups.Meanwhile,all patients completed CT perfusion(CTP)imaging before and 14 days after operation.The absolute values of cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP),mean transit time(MTT)in the infarction core area,the contralateral mirror area,and the peri-infarct zone(PIZ)were measured and compared between the two groups.Results The NIHSS scores were significantly decreased after operation compared with those before operation in the two groups(P<0.01),and the Barthel indexes were significantly increased after surgery(P<0.01).After surgery,the NIHSS score was significantly decreased in the study group compared with that of the control group,and the Barthel index was significantly increased in the study group compared with that of the control group(P<0.05).There was no significant difference in the mortality between the two groups(P>0.05).The CBF and CBV of the infarction core area were significantly increased after operation in the study group,and both were higher than those in the control group(P<0.01).In the PIZ area,the CBF was increased after operation,and MTT was decreased after operation in the control group(P<0.05).There were no significant differences in the CBV and TTP before and after operation in the control group(P>0.05).The CBF and CBV

关 键 词：脑梗死 灌注成像 减压术 外科 大面积脑梗死 CT灌注成像 标准去骨瓣减压 内减压 预后 

分 类 号：R651.1[医药卫生—外科学]