超早期颅内钻孔引流对猪急性颅内高压合并脑疝的作用  

Effect of ultra-early intracranial burr hole drainage on acute intracranial hypertension combined with brain hernia in swine

作　　者：吴红月 朱晓玲 李小蝶 牟思曈 陈少锋 邹晓素 唐日新 孙婷 滕红丽 唐华民 Wu Hongyue;Zhu Xiaoling;Li Xiaodie;Mou Sitong;Chen Shaofeng;Zou Xiaosu;Tang Rixin;Sun Ting;Teng Hongli;Tang Huamin(Emergency Department,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)

机构地区：[1]广西医科大学第二附属医院全科医学科,广西南宁530007 [2]广西医学科大学第二附属医院急诊科,广西南宁530007 [3]广西中医药大学,广西南宁530001 [4]广西国际壮医医院壮瑶医药研究实验室,广西南宁530201 [5]广西国际壮医医院急诊急救联动中心(创伤中心),广西南宁530201

出　　处：《中国急救医学》2023年第7期569-573,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金(81660327);广西科技基地和人才专项(桂科AD22035052)。

摘　　要：目的探讨超早期颅内钻孔引流对猪急性颅内高压合并脑疝(brain hernia,BH)的效果。方法通过自体股动脉血注射制备广西巴马小型猪急性颅内高压合并脑疝模型,给予钻孔引流清除血肿,监测造模前、造模后及钻孔引流术后猪颅内压(ICP)、平均动脉压(MAP)和脑灌注压(CPP)变化,并进行统计学分析。结果8只实验小型猪在穿刺引流术后6 h全部存活。在注射自体股动脉血前ICP为(7.750±2.712)mm Hg,MAP为(79.630±6.323)mm Hg,CPP为(71.880±7.180)mm Hg;在注射自体股动脉血的过程中ICP、MAP和CPP逐渐上升,与注射自体股动脉血后ICP为(53.130±2.295)mm Hg,MAP为(133.381±2.070)mm Hg,CPP为(80.250±2.407)mm Hg比较,差异均有统计学意义(P<0.001)。穿刺引流血肿清除术后ICP、MAP和CPP逐渐下降,ICP为(19.880±1.553)mm Hg,CPP为(48.630±8.366)mm Hg,与穿刺引流术前比较差异有统计学意义(P<0.05);在行穿刺引流前MAP稳定在(62.000±5.855)mm Hg,穿刺引流后MAP为(68.500±8.519)mm Hg,穿刺引流术前后MAP比较差异无统计学意义(P>0.05)。结论超早期颅内钻孔引流可迅速、有效地降低实验小型猪颅内压,改善脑灌注,可用于急性颅内高压合并BH的急救。Objective To investigate the effect of ultra-early intracranial burr hole drainage on the treatment of acute intracranial hypertension combined with brain hernia.Methods The models of acute intracranial hypertension complicated with brain hernia of Guangxi Bama mini swine were established by injecting autologous femoral artery blood.The hematoma was removed by drilling and drainage,and the changes of intracranial pressure(ICP),mean arterial pressure(MAP)and cerebral perfusion pressure(CPP)were monitored before modeling,after modeling and after drilling and drainage,and were analyzed statistically.Results All 8 experimental animals survived 6 h after puncture and drainage.ICP,MAP and CPP were(7.750±2.712)mm Hg,(79.630±6.323)mm Hg and(71.880±7.180)mm Hg before arterial blood injection.Compared with ICP(53.130±2.295)mm Hg,MAP(133.381±12.070)mm Hg and CPP(80.250±12.407)mm Hg after the injection of arterial blood,the differences were statistically significant(P<0.001).ICP,MAP and CPP gradually decreased after hematoma removal surgery,ICP was(19.880±1.553)mm Hg and CPP was(48.630±8.366)mm Hg,and there were statistically significant differences compared with before puncture and drainage(P<0.05).There was no significant difference in MAP before and after puncture and drainage[(62.000±5.855)mm Hg vs.(68.500±8.519)mm Hg,P>0.05].Conclusions Burr hole drainage can effectively reduce intracranial pressure and improve cerebral perfusion in a short time,and could be used in the early treatment of acute intracranial hypertension complicated with brain hernia.

关 键 词：创伤性脑损伤(TBI) 颅内压(ICP) 脑灌注压(CPP) 平均动脉压(MAP) 钻孔引流 颅内出血(ICH) 脑疝(BH) 

分 类 号：R651.1[医药卫生—外科学] R-332[医药卫生—临床医学]