深入理解控制性减压技术对创伤性颅脑损伤术中脑膨出的预防机制与效果  

Further understanding of the prevention mechanism and effects for intraoperative encephalocele by controlled decompression technique in patients with traumatic brain injury

作　　者：王守森 傅世龙 鲜亮 林珑 Shousen Wang;Shilong Fu;Liang Xian;Long Lin(Department of Neurosurgery,Fuzong Clinical Medical College of Fujian Medical University(the 900th Hospital of Joint Logistics Force),Fuzhou 350025,China;Department of Neurosurgery,the First Hospital of Putian City,Putian 351100,China)

机构地区：[1]福建医科大学福总临床医学院解放军(联勤保障部队第九〇〇医院)神经外科,福州350025 [2]莆田市第一医院神经外科,莆田351100

出　　处：《中华神经创伤外科电子杂志》2024年第5期257-262,共6页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：福建省科技计划科技创新平台项目(2022Y2017)

摘　　要：急性脑膨出是创伤性颅脑损伤(TBI)开颅术中的危急现象,其常见诱因包括迟发性血肿、大面积脑梗死和弥漫性脑肿胀等,预后通常极差。近年来,随着控制性颅内减压(CID)理念及相关技术的推广应用,术中脑膨出的发生率已明显下降,但仍会出现脑膨出未能成功预防的情况,尤其是存在严重弥漫性脑肿胀时。外伤性脑肿胀(TBS)是原发性脑膨出的重要基础,两者的病理机制较为复杂,因此对CID技术的临床效果应理性看待,并探索TBS的新理论和机制。本文主要针对TBS及原发性脑膨出的机制、CID技术的操作要点及其对脑膨出的预防机制与效果作一述评,以期为提高TBI患者的手术成功率提供参考。Acute brain bulge is a critical phenomenon in open surgery for traumatic brain injury(TBI),with common causes including delayed hematoma,massive cerebral infarction and diffuse cerebral swelling,the prognosis is usually very poor.In recent years,with the promotion and application of the concept of controlled intracranial decompression(CID)and related technologies,the incidence of intraoperative brain bulge has decreased significantly.However,some patients still suffer from brain bulge,especially those with severe diffuse cerebral swelling.Traumatic brain swelling(TBS)is an important basis for primary brain bulge,and the pathological mechanisms of both are complex.Therefore,the clinical efficacy of CID technology should be viewed rationally,and new theories and mechanisms of TBS should be explored.This article mainly reviews the mechanisms of TBS and primary brain bulge,the operational principles of CID technology,and its preventive mechanism and effect,with the aim of providing reference for improving the success rate of surgery for TBI patients.

关 键 词：创伤性颅脑损伤 急性脑膨出 控制性减压技术 外伤性脑肿胀 脑血流动力学 

分 类 号：R651.1[医药卫生—外科学]