小骨瓣开颅血肿清除术联合骨瓣复位术治疗脑出血脑疝的价值研究  

Study on the Value of Small Bone Flap Craniotomy Hematoma Removal Combined with Bone Flap Repositioning in the Treatment of Cerebral Hemorrhage Cerebral Hernia

作　　者：叶林 陈森 聂文 刘娟 祁晓瑜 YE Lin;CHEN Sen;NIE Wen;LIU Juan;QI Xiaoyu(Department of Neurosurgery,Jiaozhou Hospital of Dongfang Hospital Affiliated to Tongji University,Qingdao,Shandong Province,266300 China;Intensive Care Unit,Jiaozhou Hospital of Dongfang Hospital Affiliated to Tongji University,Qingdao,Shandong Province,266300 China;Department of International Medicine,Jiaozhou Hospital of Dongfang Hospital Affiliated to Tongji University,Qingdao,Shandong Province,266300 China)

机构地区：[1]同济大学附属东方医院胶州医院神经外科,山东青岛266300 [2]同济大学附属东方医院胶州医院重症监护室,山东青岛266300 [3]同济大学附属东方医院胶州医院国际医学部,山东青岛266300

出　　处：《中外医疗》2024年第16期4-8,共5页China & Foreign Medical Treatment

摘　　要：目的探讨小骨瓣开颅血肿清除术联合骨瓣复位术治疗脑出血脑疝的临床价值。方法前瞻性随机选择2022年2月—2023年9月同济大学附属东方医院胶州医院收治的80例高血压基底节部位出血导致脑疝形成患者为研究对象。按照随机数表法分为两组,各40例。对照组行大骨瓣开颅血肿清除结合去骨瓣减压术,观察组实施小骨瓣开颅血肿清除术结合颅骨修补术,比较两组术后血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)、碱性成纤维细胞生长因子(Basic Fibroblast Growth Factor,bFGF)、内皮素-1(Endothelin-1,ET-1)和一氧化氮(Nitric Oxide,NO)水平变化,统计两组术后炎症因子及颅内压变化。结果术后观察组VEGF和bFGF水平分别为(80.2±9.3)pg/mg和(42.9±6.3)pg/mg,均高于对照组,差异有统计学意义(t=9.915、16.997,P均<0.05),观察组ET-1水平低于对照组,NO水平高于对照组,差异有统计学意义(P均<0.05),观察组超敏-C反应蛋白与肿瘤坏死因子-α均低于对照组,差异有统计学意义(P均<0.05),观察组颅内压低于对照组,脑灌注压明显高于对照组,差异有统计学意义(P均<0.05)。结论针对高血压基底节区脑出血并发脑疝者,行小骨瓣开颅血肿清除术联合骨瓣复位术治疗,可有效地改善术后血管内皮生长功能,减轻炎症反应,降低颅内压。Objective To explore the clinical value of small bone flap craniotomy hematoma removal combined with bone flap repositioning in the treatment of cerebral hemorrhage cerebral hernia.Methods A total of 80 patients with hypertensive basal ganglia hemorrhage resulting in cerebral hernia formation admitted to Jiaozhou Hospital of Dongfang Hospital Affiliated to Tongji University from February 2022 to September 2023 were prospective randomly selected as the study objects.They were divided into two groups according to the method of random number table method,each with 40 cases.In the control group,large bone flap craniotomy hematoma removal combined with debridement decompression surgery was performed,and in the observation group,small bone flap craniotomy hematoma removal combined with cranial bone repair was performed.The postoperative levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), endothelin-1 (ET-1), and nitric oxide (NO) were compared between the two groups, and the changes of inflammatory factors and intracranial pressure between the two groups were counted after surgery. Results Postoperative VEGF and bFGF levels in the observation group were (80.2±9.3) pg/mg and (42.9±6.3) pg/mg, respectively, which were higher than those in the control group, and the differences were statis tically significant (t=9.915, 16.997, both P<0.05). The level of ET-1 in the observation group was lower than that in the control group, and the level of NO was higher than that in the control group, the differences were statistically sig nificant (both P<0.05). high-sensitivity -C-reactive protein and tumor necrosis factor α in the observation group were lower than those in the control group, and the differences were statistically significant (both P<0.05). The intra cranial pressure of the observation group was lower than that of the control group, and the cerebral perfusion pressure was significantly higher than that of the control group, and the differences were statistically significant (b

关 键 词：小骨瓣开颅血肿清除 骨瓣复位 脑出血 脑疝 

分 类 号：R651.1[医药卫生—外科学]