改良去骨瓣减压术对重型颅脑损伤患者脑血流及脑氧代谢的影响  

Effect of Modified Decompressive Craniectomy on Cerebral Blood Flow and Cerebral Oxygen Metabolism in Patients with Severe Craniocerebral Injury

作　　者：唐逸人 张巍 黄永锋 TANG Yiren;ZHANG Wei;HUANG Yongfeng(Emergency Department of Jianli Traditional Chinese Medicine Hospital,Jianli 433300,China;不详)

机构地区：[1]监利市中医医院急诊科,湖北监利433300 [2]监利市人民医院神经外科,湖北监利433300

出　　处：《中国医学创新》2024年第27期58-61,共4页Medical Innovation of China

基　　金：湖北省卫生健康委科技计划项目(20193589)。

摘　　要：目的:探讨改良去骨瓣减压术在重型颅脑损伤中的疗效及对脑血流及脑氧代谢的影响。方法:选择2020年1月—2022年1月在监利市中医医院治疗的重型颅脑损伤患者120例按照其接受治疗方法的异同将其分组,60例患者接受传统去骨瓣减压术,将其划分为对照组;60例患者接受改良去骨瓣减压术,将其划分为观察组,对比两组患者的美国国立卫生研究院卒中量表(NIHSS)评分及血清神经元特异性烯醇化酶(NSE)水平、脑血流动力学指标、脑氧代谢指标及并发症发生率。结果:术后,两组的NIHSS评分、NSE水平、双侧颈内动脉搏动指数(PI)、颈内动脉血氧含量(CaO_(2))均降低,观察组均低于对照组,收缩期最大血流速度(Vs)、平均血流速度(Vm)、脑氧摄取率(CERO_(2))、颈内静脉血氧含量(CjvO_(2))及颈静脉球部氧饱和度(SjvO_(2))均上升,观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组的并发症发生率(1.67%)低于对照组(11.67%),差异有统计学意义(P<0.05)。结论:重型颅脑损伤患者行改良去骨瓣减压术治疗,能够减轻神经损伤,改善脑血流动力学、脑氧代谢能力,减少并发症,安全有效。Objective:To explore the therapeutic effect of modified decompressive craniectomy in severe craniocerebral injury and its impact on cerebral blood flow and cerebral oxygen metabolism.Method:A total of 120 patients with severe craniocerebral injury who received treatment at Jianli Traditional Chinese Medicine Hospital from January 2020 to January 2022 were selected and grouped according to their similarities and differences in treatment methods.Sixty patients underwent traditional decompressive craniectomy and were divided into the control group;sixty patients underwent modified decompressive craniectomy and were divided into the observation group.The national institutes of health stroke scale(NIHSS)scores,serum neuron specific enolase(NSE)levels,cerebral hemodynamic indicators,cerebral oxygen metabolism indicators and incidence of complications were compared between the two groups of patients.Result:After surgery,the NIHSS score,NSE level,bilateral internal carotid artery pulsatility index(PI)and internal carotid artery oxygen content(CaO_(2))of both groups decreased,those of the observation group were lower than those of the control group,and the maximum systolic blood flow velocity(Vs),average blood flow velocity(Vm),cerebral oxygen uptake rate(CERO_(2)),internal jugular vein oxygen content(CjvO_(2))and jugular bulb venous oxygen saturation(SjvO_(2))all increased,those of the observation group were higher than those of the control group,the differences were statistically significant(P<0.05).The incidence of complications in the observation group(1.67%)was lower than that in the control group(11.67%),the difference was statistically significant(P<0.05).Conclusion:Modified decompressive craniectomy in patients with severe craniocerebral injury can alleviate nerve damage,improve cerebral hemodynamics and oxygen metabolism,reduce complications,and be safe and effective.

关 键 词：重型颅脑损伤 改良去骨瓣减压术 神经功能 脑血流动力学 脑氧代谢 

分 类 号：R651.15[医药卫生—外科学]