不同监测方式在老年重型颅脑损伤去骨瓣减压术后的应用价值  

Application Value of Different Monitoring Methods in Elderly Patients with Severe Craniocerebral Injury after Decompressive Craniectomy

作　　者：孙晓峰[1] 张立[1] 钱晓波[1] 季东凯 李建[1] 倪海波[1] 刘诚林 SUN Xiaofeng;ZHANG Li;QIAN Xiaobo;JI Dongkai;LI Jian;NI Haibo;LIU Chenglin(Zhangjiagang First People's Hospital,Jiangsu Province,Zhangjiagang 215600,China)

机构地区：[1]江苏省张家港市第一人民医院,江苏张家港215600

出　　处：《中国医学创新》2023年第15期154-157,共4页Medical Innovation of China

摘　　要：目的:考察不同监测方式在老年重型颅脑损伤去骨瓣减压术后的应用价值。方法:选取2020年1月-2022年6月张家港市第一人民医院神经外科收治的拟行去骨瓣减压术的老年重型颅脑损伤患者60例作为研究对象。所有患者在去骨瓣减压术后均采用床旁超声和颅脑CT进行检查。比较两种监测方式对血肿情况、侧脑室宽度、中线移位、出血量及迟发症状的检出情况。结果:床旁超声法和颅脑CT法检出的血肿上下径、前后径和左右径比较,差异均无统计学意义(P>0.05)。床旁超声法和颅脑CT法检出的侧脑室宽度绝对值、中线移位和出血量比较,差异均无统计学意义(P>0.05)。相比于床旁超声法,颅脑CT法迟发症状总检出率更高,差异有统计学意义(P<0.05)。结论:床旁超声和颅脑CT在经去骨瓣减压术治疗的重型颅脑损伤患者的监测中均有较高的临床价值。床旁超声可行动态监测,具有无创性,相对更为便捷,颅内CT对术后迟发症状的检出相对更高,临床可依据患者具体情况选择更为适宜的监测方式。Objective:To investigate the application value of different monitoring methods in elderly patients with severe craniocerebral injury after decompressive craniectomy.Method:A total of 60 elderly patients with severe craniocerebral injury who were admitted to the Department of Neurosurgery,Zhangjiagang First People's Hospital from January 2020 to June 2022 and were planning to undergo decompressive craniectomy were selected as the research subjects.All patients were examined with bedside ultrasound and cerebral CT after decompressive craniectomy.The detection of hematoma,lateral ventricle width,midline shift,bleeding volume and delayed symptoms by the two monitoring methods were compared.Result:There were no significant differences in the upper and lower diameter,anterior and posterior diameter and left and right diameter of hematoma detected by bedside ultrasound and cerebral CT(P>0.05).There were no significant differences in the absolute value of lateral ventricular width,midline shift and bleeding volume detected by bedside ultrasound and cerebral CT(P>0.05).Compared with the bedside ultrasound method,the total detection rate of delayed symptoms with cerebral CT method was higher,the difference was statistically significant(P<0.05).Conclusion:Both bedside ultrasound and brain CT have high clinical value in elderly patients with severe craniocerebral injury treated by decompressive craniectomy.Bedside ultrasound is feasible for dynamic monitor,and is non-invasive,relatively more convenient.Intracranial CT has a higher detection rate of delayed symptoms after operation,so a more suitable monitoring method can be selected according to the specific situation of patients.

关 键 词：重型颅脑损伤 去骨瓣减压术 颅脑CT 床旁超声 

分 类 号：R651.15[医药卫生—外科学]