大脑半球大面积梗死患者标准大骨瓣减压术围手术期颅内压变化研究  

Intracranial pressure changes at perioperative period in patients with large hemispheric infarction after standard large bone flap decompression

作　　者：郭玉龙 孟凡东 李永飞 马媛媛[3] 王玉社[4] Guo Yulong;Meng Fandong;Li Yongfei;Ma Yuanyuan;Wang Yushe(Department of Neurosurgery,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Neurosurgery,People's Hospital of He'nan University,Zhengzhou 450003,China;Department of Anesthesiology and Perioperative Surgery,He'nan Provincial People's Hospital,Zhengzhou 450003,China;Department of Neurosurgery,He'nan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院神经外科,郑州450003 [2]河南大学人民医院神经外科,郑州450003 [3]河南省人民医院麻醉与围手术期科,郑州450003 [4]河南省人民医院神经外科,郑州450003

出　　处：《中华神经医学杂志》2024年第6期578-584,共7页Chinese Journal of Neuromedicine

摘　　要：目的探讨大脑半球大面积梗死(LHI)患者标准大骨瓣减压术围手术期颅内压变化及其与患者神经功能恢复、术中骨窗相关参数的关系。方法选择自2020年12月至2023年12月于郑州大学人民医院神经外科接受标准大骨瓣减压术的40例LHI患者为研究对象。所有患者均分别于术前、去除骨瓣时、切开硬脑膜时及术后24 h时测量颅内压,应用Pearson相关检验分析患者手术前后美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥预后量表扩展版(GOSE)评分、格拉斯哥昏迷量表(GCS)评分变化以及骨窗长径、面积、骨窗面积/颅盖骨总面积值、梗死脑组织体积/总脑组织体积值与术后24 h较术前颅内压降低幅度的相关性,并统计神经功能恢复较好(手术前后NIHSS评分降低≥5分、GOSE评分升高≥3分、GCS评分升高≥3分)患者的骨窗长径、面积范围。结果去除骨瓣时、切开硬脑膜时和术后24 h时患者颅内压均明显低于术前,差异均有统计学意义(P<0.05),其中去除骨瓣时颅内压相对最高,其次是术后24 h时和切开硬脑膜时;切开硬脑膜时较术前颅内压降低幅度明显高于术后24 h时较术前降低幅度、去除骨瓣时较术前降低幅度,差异均有统计学意义(P<0.05);患者术后NIHSS评分明显低于术前,GOSE、GCS评分明显高于术前,差异均有统计学意义(P<0.05)。患者手术前后NIHSS评分降低值、GOSE和GCS评分升高值与术后24 h较术前颅内压降低幅度呈正相关关系(r=0.386,P=0.018;r=0.411,P=0.033;r=0.319,P=0.037),骨窗长径、面积与术后24 h较术前颅内压降低幅度呈正相关关系(r=0.461,P=0.028;r=0.536,P=0.034),梗死脑组织体积/总脑组织体积值与术后24 h较术前颅内压降低幅度呈负相关关系(r=-0.371,P=0.031),骨窗面积/颅盖骨总面积值与术后24 h较术前颅内压降低幅度呈正相关关系(r=0.438,P=0.027)。40例患者中25例术后神经功能恢复较好,其骨窗长径范围为Objective To explore the correlations of neurological function recovery and intraoperative bone window parameters with intracranial pressure(ICP)changes at perioperative period in patients with large hemispheric infarction(LHI)after standard large bone flap decompression.Methods Forty LHI patients accepted standard large bone flap decompression in Department of Neurosurgery,People's Hospital of Zhengzhou University from December 2020 to December 2023 were enrolled.ICP was measured before decompression,at the time of bone flap removal,during dural opening,and 24 h after decompression.Correlations of National Institutes of Health Stroke Scale(NIHSS),Extended Glasgow Outcome Scale(GOSE)and Glasgow Coma Scale(GCS)score changes,length and area of the bone window,bone window area/cranial bone area,infarct brain tissue volume/brain tissue volume with ICP changes were analyzed by Pearson's correlation.Length and area of bone window in patients with good neurological function recovery(NIHSS score decreased by≥5,GOSE score increased by≥3,or GCS score increased by≥3 before and after decompression)were calculated.Results ICP at the time of bone flap removal,during dural opening,and 24 h after decompression was significantly lower than that before decompression(P<0.05);ICP at the time of bone flap removal was higher than that at 24 h after decompression and during dural opening.Reduction between ICP before decompression and that during dural opening was more obvious than ICP reduction before and 24 h after decompression and ICP reduction before decompression and at the time of bone flap removal,with significant differences(P<0.05).Postoperative NIHSS scores were significantly lower than preoperative ones(P<0.05),and both postoperative GOSE and GCS scores were significantly higher than preoperative ones(P<0.05).Decrease of NIHSS score,increase of GOSE and GCS scores before and after decompression were positively correlated with ICP reduction before and 24 h after decompression(r=0.386,P=0.018;r=0.411,P=0.033;r=0.319,P=0.

关 键 词：大脑半球大面积梗死 标准大骨瓣减压术 颅内压 

分 类 号：R651.1[医药卫生—外科学]