V-P分流术不同穿刺位置联合同期颅骨修补术在颅脑损伤脑积水患者中的应用  

Application of different puncture positions of V-P shunt combined with simultaneous cranio⁃plasty in hydrocephalus after head injury

作　　者：申剑波 茹小红 SHEN Jianbo;RU Xiaohong(Jincheng People’s Hospital,Jincheng 048000,China)

机构地区：[1]晋城市人民医院,山西晋城048000

出　　处：《中国实用神经疾病杂志》2023年第10期1269-1274,共6页Chinese Journal of Practical Nervous Diseases

基　　金：山西省医学重点科研项目(编号:2022XM24);晋城市科技局项目(编号:20210104)。

摘　　要：目的探讨脑室-腹腔(V-P)分流术不同穿刺位置联合同期颅骨修补术在颅脑损伤脑积水患者中的效果及对凝血功能、粒系集落刺激因子(G-CSF)、肿瘤坏死因子-α(TNF-α)的影响。方法回顾性分析2020-06—2022-06晋城市人民医院121例颅脑损伤脑积水患者临床资料,根据手术方案分为A组(n=61)和B组(n=60),分别行V-P分流术(副三角区穿刺)+颅骨修补术、V-P分流术(侧脑室三角区穿刺)+颅骨修补术。统计2组脑积水改善情况、并发症、预后,对比术前、术后凝血功能、G-CSF、TNF-α、脑灌注情况、神经功能评分(NIHSS)。结果A组脑积水改善总有效率81.97%与B组80.00%比较,差异无统计学意义(P>0.05)。术后3 d、7 d A组血清APTT、PT水平低于B组,Fbg水平高于B组(P<0.05)。术后1个月A组血清G-CSF水平高于B组,TNF-α水平低于B组(P<0.05)。术前2组NIHSS评分、ICP、CCP比较,差异无统计学意义(P>0.05),术后1个月、3个月2组NIHSS评分、ICP低于术前,CCP高于术前(P<0.05)。A组并发症发生率(6.56%)低于B组(20.00%,P<0.05)。术后3个月,A组预后优良率(66.67%)与B组(67.24%)比较,差异无统计学意义(P>0.05)。结论V-P分流术不同穿刺位置联合同期颅骨修补术治疗颅脑损伤脑积水疗效相当,特别是副三角区穿刺,可减少并发症,降低血清G-CSF、TNF-α水平,且对凝血功能影响较小。Objective To investigate the effect of different puncture positions of ventricular-peritoneal(V-P)shunt combined with simultaneous cranioplasty in hydrocephalus after head injury and its influence on blood coagulation function,granulocyte colony stimulating factor(G-CSF)and tumor necrosis factor-α(TNF-α).Methods The clinical data of 121 patients with craniocerebral injury and hydrocephalus in Jincheng pesple’s hospital from June 2020 to June 2022 were retrospectively analyzed.According to the surgical plan,they were divided into group A(n=61)and group B(n=60).VP shunt(accessory triangle puncture)+skull repair,VP shunt(lateral ventricle triangle puncture)+skull repair surgery.They performed V-P shunt(accessory triangle puncture)+cranioplasty,V-P shunt(lateral ventricle triangle puncture)+cranioplasty.The improvement,complications,and prognosis of hydrocephalus in the two groups were counted,and the coagulation function,G-CSF,TNF-α,cerebral perfusion,and nerve function(NIHSS)were compared before and after the operation.Results 81.97%of the total effective rate of hydrocephalus improvement in group A was compared with 80.00%in group B,and there was no significant difference(P>0.05).Serum APTT and PT levels in group A were lower than those in group B at 3 and 7 days after operation,and Fbg levels were higher than that in group B(P<0.05).The serum G-CSF level of group A was higher than that of group B,and the level of TNF-αwas lower than that of group B one month after operation(P<0.05).There was no statistically significant difference in NIHSS score,ICP,and CCP between the two groups before operation(P>0.05).The NIHSS score and ICP of the two groups were lower than that before operation at 1 month and 3 months after operation,and CCP was higher than that before operation(P<0.05).The complication rate of group A was 6.56%lower than that of group B(20.00%,P<0.05).Three months after the operation,the prognostic excellent rate of group A was 66.67%compared with 67.24%of group B,and there was no significant differen

关 键 词：颅脑损伤 脑积水 颅骨修补术 V-P分流术 粒系集落刺激因子 肿瘤坏死因子-Α 

分 类 号：R651.15[医药卫生—外科学]