脑-硬脑膜-肌肉血管重建联合标准大骨瓣减压术治疗重型颅脑损伤的临床研究  

Clinical Study of Brain-dura-muscle Vascular Reconstruction Combined with Standard Decompressive Craniectomy in the Treatment of Severe Craniocerebral Injury

作　　者：冯海滨[1] 张宗平[1] 谭鑫[1] 袁炳文 曾火勇[1] FENG Hai-bin;ZHANG Zong-ping;TAN Xin(Guangdong Agri-cultural Reclamation Central Hospital,Zhanjiang,Guangdong,524000,China)

机构地区：[1]广东省农垦中心医院,广东湛江524000

出　　处：《黑龙江医学》2022年第19期2330-2332,2335,共4页Heilongjiang Medical Journal

基　　金：湛江市科技计划项目(2017B01006)。

摘　　要：目的:探讨重型颅脑损伤患者采用脑-硬脑膜-肌肉血管重建联合标准大骨瓣减压术治疗的临床效果。方法:选择2018年6月-2020年6月广东省农垦中心医院收治的70例重型颅脑损伤患者作为研究对象,随机分成对照组和观察组,每组各35例。对照组行标准大骨瓣减压术,观察组行脑-硬脑膜-肌肉血管重建联合标准大骨瓣减压术。比较两组患者血流动力学[脑血容量(CBV)、脑血流量(CBF)、达峰时间(TTP)、平均通过时间(MTT)、rCBF、rCBV、rMTT、rTTP]、颅内压水平、并发症及预后情况。结果:观观察组术后CBF、CBV、rCBF、rCBV均高于对照组,MTT、TTP、rMTT、rTTP低于对照组,差异有统计学意义(t=4.282、9.028、3.127、8.741、12.841、11.951、13.755、17.590,P<0.05);观察组术后3 d、5 d、7 d颅内压水平均低于对照组,差异有统计学意义(t=6.960、12.875、16.554,P<0.05);观察组并发症发生率较对照组低,差异有统计学意义(χ^(2)=4.590,P<0.05);观察组预后情况优于对照组,差异有统计学意义(Z=3.421,P<0.05)。结论:在标准大骨瓣减压术基础上,重型颅脑损伤患者加用脑-硬脑膜-肌肉血管重建利于改善患者血流动力学,降低颅内压水平,减少术后并发症发生,改善患者预后。Objective:To investigate the clinical effect of brain-dura-muscle vascular reconstruction combined with standard large decompressive craniectomy in patients with severe craniocerebral injury.Methods:A total of 70 patients with severe craniocerebral injury who were admitted to the hospital from June 2018 to June 2020 were selected as the research objects and randomly divided into control group and observation group,with 35 cases in each group.The control group received standard large bone craniectomy,while the observation group received brain-dura-muscle vascular reconstruction combined with standard large bone craniectomy.The hemodynamics(cerebral blood volume[CBV],cerebral blood flow[CBF],time to peak[TTP],mean transit time[MTT],rCBF,rCBV,rMTT,rTTP),intracranial pressure level,complications and prognosis of the two groups were compared.Results:After operation,the CBF,CBV,rCBF and rCBV of the observation group were higher than those of the control group,and the MTT,TTP,rMTT and rTTP of the observation group were lower than those of the control group,and the differences were statistically significant(t=4.282,9.028,3.127,8.741,12.841,11.951,13.755,17.590,P<0.05).The intracranial pressure levels of the observation group were lower than those of the control group at 3 d,5 d and 7 d after operation,and the differences were statistically significant(t=6.960,12.875,16.554,P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(χ^(2)=4.590,P<0.05).The prognosis of the observation group was better than that of the control group,and the difference was statistically significant(Z=3.421,P<0.05).Conclusion:On the basis of standard large decompressive craniectomy,the addition of brain-dural-muscle vascular reconstruction in patients with severe craniocerebral injury can improve the patients’hemodynamics,reduce the level of intracranial pressure,reduce postoperative complications,and improve the prognosis of patients.

关 键 词：重型颅脑损伤 脑—硬脑膜—肌肉血管重建 标准大骨瓣减压术 血流动力学 并发症 

分 类 号：R651.15[医药卫生—外科学]