渐进减压对重型颅脑损伤改良大骨瓣减压术患者颅内压 及脑脊液动力学的影响  

Effect of progressive decompression on intracranial pressure and CSF dynamics in patients with severe craniocerebral injury undergoing modified large flap decompression

作　　者：朱晓忠 康秋红 康平[1] 曾文 刘生明[1] ZHU Xiao-zhong;KANG Qiu-hong;KANG Ping(Department of encephalopathy,Taihe County Hospital of traditional Chinese medicine,Ji'an City,Jiangxi Province,Ji'an 343700,China)

机构地区：[1]江西省吉安市泰和县中医院脑病科,江西吉安343700

出　　处：《吉林医学》2021年第4期807-809,共3页Jilin Medical Journal

摘　　要：目的:研究渐进减压对重型颅脑损伤改良大骨瓣减压术患者颅内压及脑脊液动力学的影响。方法:按随机数字表法将89例重型颅脑损伤分为对照组(42例)和观察组(47例)。两组患者均行重型颅脑损伤改良大骨瓣减压术,对照组使用常规一次性减压手术方案,观察组行渐进减压手术方案。观察并对比两组患者术前以及术后不同时间段的颅内压、术后脑脊液动力学[足向流动起始时间(SS)、足向流动起始时间在心动周期内的比例(SS/RI)、足向流动持续时间在心动周期内的比例(SC/RD)、足向流动终止时间(SE)、脑脊液足向流动持续时间(SC)、R-R间期(RI)和足向流动最大流速(MSV)、头向流动最大流速(MDV)]指标的变化情况。结果:两组术前颅内压差异无统计学意义(P>0.05);观察组术后1 d、术后3 d及术后5 d的颅内压低于对照组,差异有统计学意义(P<0.05);两组脑脊液SS、SS/RI和SC/RI比较差异无统计学意义(P>0.05);观察组脑脊液SE、SC、RI和MSV大于对照组,MDV小于对照组,差异有统计学意义(P<0.05)。结论:重型颅脑损伤患者行改良大骨瓣减压术时实施渐进减压方案,有助于降低患者颅内压,改善脑脊液动力学。Objective To study the effect of progressive decompression on intracranial pressure and CSF dynamics in patients with severe craniocerebral injury undergoing modified large bone flap decompression.Method 89 cases of severe craniocerebral injury in our hospital were divided into control group(42 cases)and observation group(47 cases)according to random number table method.The patients in the two groups were treated with modified large bone flap decompression for severe craniocerebral injury.The patients in the control group were treated with conventional one-time decompression operation,and the patients in the observation group were treated with gradual decompression operation.The index changes of intracranial pressure,CSF dynamics[SS,SS/RI,SC/RD,SE,SC,RI,Dynamic maximum velocity(MSV)and head flow maximum velocity(MDV)]were observed and compared before and after operation in two groups.Results There was no significant difference in ICP between the two groups(P>0.05);ICP in the observation group was lower than that in the control group on postoperative day 1,postoperative day 3 and postoperative day 5(P<0.05);there was no significant difference in CSF SS,SS/RI and SC/RI between the two groups(P>0.05);SE,SC,RI and MSV in the observation group were higher than those in the control group,and MDV was lower than those in the control group(P<0.05).Conclusion Gradual decompression is helpful to reduce intracranial pressure and improve cerebrospinal fluid dynamics in patients with severe craniocerebral injury.

关 键 词：重型颅脑损伤 渐进减压 改良大骨瓣减压术 颅内压 脑脊液动力学 

分 类 号：R651.15[医药卫生—外科学]