持续泵注尼莫地平下控制性减压术防治老年颅脑损伤并发脑梗死的临床研究
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摘要
目的探讨持续泵注尼莫地平下控制性减压术防治老年颅脑损伤并发脑梗死的临床效果。方法纳入我院2017年9月至2018年2月收治的80例老年颅脑损伤病人,将其中行持续泵入尼莫地平下控制性减压术治疗的40例病人设为观察组,行标准大骨瓣减压术治疗的40例病人设为对照组。比较2组不同时点(术中、术毕、术后6个月)颅内压变化情况,术后脑梗死发生情况及脑梗死体积,术后6个月相关预后评估量表[格拉斯哥预后量表(GOS)、神经行为认知状态检查表(NCSE)、Barthel指数(BI)]评分结果。结果观察组术中、术毕、术后6个月颅内压均较对照组同时点显著降低(P<0. 05)。观察组脑梗死发生率为5. 00%,显著低于对照组的25. 00%(P<0. 05);观察组平均脑梗死体积为(5. 87±1. 14) cm3,显著小于对照组的(11. 72±2. 96) cm3(P<0. 01)。观察组术后6个月GOS、NCSE及BI评分均较对照组显著升高(P<0. 01)。结论持续泵注尼莫地平下控制性减压术治疗老年重型颅脑损伤疗效显著,能有效控制颅内高压,降低术后脑梗死发生率,改善病人预后。
Objective To explore the clinical effect of controlled decompression with continuous pumping of nimodipine to prevent cerebral infarction in the elderly with craniocerebral injury. Methods A total of 80 elderly patients with craniocerebral injury who were treated in our hospital from September2017 to February 2018 were included. Forty patients who underwent continuous pumping of nimodipine complicated with controlled decompression were set as the observation group,and forty patients receiving standard large bone flap decompression were set as the control group. All patients were followed up for 6 months. The changes in intracranial pressure,the incidence rate of postoperative cerebral infarction and cerebral infarction volume were compared between the two groups. And the relevant prognosis evaluation scale including Glasgow prognosis scale( GOS), neurobehavioral cognitive status examination table( NCSE) and Barthel index( BI) were evaluated and compared between two groups 6 months after surgery.Results The intracranial pressure in the observation group was significantly lower than that in the control group 6 months after surgery( P<0. 05). The incidence rate of cerebral infarction was 5. 00%,and the average cerebral infarction volume was( 5. 87 ± 1. 14) cm3 in the observation group,compared with25. 00% and( 11. 72 ± 2. 96) cm3 in the control group,respectively. The incidence rate of cerebral infarction and the average cerebral infarction volume in the observation group were significantly lower than those in the control group( P<0. 05 or P<0. 01). GOS,NCSE and BI scores in the observation group were significantly higher than those in the control group 6 months after surgery( P<0. 01). Conclusions The controlled decompression with continuous infusion of nimodipine is effective in the treatment of severe craniocerebral injury in the elderly,which can effectively control intracranial hypertension,reduce the incidence of postoperative cerebral infarction,and improve the prognosis of patients.
Objective To explore the clinical effect of controlled decompression with continuous pumping of nimodipine to prevent cerebral infarction in the elderly with craniocerebral injury. Methods A total of 80 elderly patients with craniocerebral injury who were treated in our hospital from September2017 to February 2018 were included. Forty patients who underwent continuous pumping of nimodipine complicated with controlled decompression were set as the observation group,and forty patients receiving standard large bone flap decompression were set as the control group. All patients were followed up for 6 months. The changes in intracranial pressure,the incidence rate of postoperative cerebral infarction and cerebral infarction volume were compared between the two groups. And the relevant prognosis evaluation scale including Glasgow prognosis scale( GOS), neurobehavioral cognitive status examination table( NCSE) and Barthel index( BI) were evaluated and compared between two groups 6 months after surgery.Results The intracranial pressure in the observation group was significantly lower than that in the control group 6 months after surgery( P<0. 05). The incidence rate of cerebral infarction was 5. 00%,and the average cerebral infarction volume was( 5. 87 ± 1. 14) cm3 in the observation group,compared with25. 00% and( 11. 72 ± 2. 96) cm3 in the control group,respectively. The incidence rate of cerebral infarction and the average cerebral infarction volume in the observation group were significantly lower than those in the control group( P<0. 05 or P<0. 01). GOS,NCSE and BI scores in the observation group were significantly higher than those in the control group 6 months after surgery( P<0. 01). Conclusions The controlled decompression with continuous infusion of nimodipine is effective in the treatment of severe craniocerebral injury in the elderly,which can effectively control intracranial hypertension,reduce the incidence of postoperative cerebral infarction,and improve the prognosis of patients.
引文
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[12]林其炎,何素娇,零达尚,等.老年颅脑损伤患者并发创伤性脑梗死的危险因素研究[J].实用心脑肺血管病杂志,2015,23(7):136-138.
[13]刘斌.中重度颅脑外伤患者继发急性外伤性脑梗死的危险因素和预后分析[J].安徽医药,2016,20(11):2104-2106.
[14]林岚.尼莫地平对重症颅脑损伤患者组织氧分压和血流动力学的影响[J].中国实用神经疾病杂志,2017,20(4):61-63.
[15]朱峰.早期应用尼莫地平对重度颅脑损伤患者血钠、血钾、血糖、C反应蛋白的影响及预防大面积脑梗塞的作用[J].海南医学院学报,2013,19(12):1665-1668.
[2]陈亚军,蒋宇钢,刘少波.控制性阶梯式减压术治疗重型、特重型颅脑损伤疗效分析[J].中国临床神经外科杂志,2015,20(3):175-177.
[3]杨波,丁文学,尚爱加,等.动脉瘤介入术后予尼莫地平动脉内灌注治疗蛛网膜下腔出血后脑血管痉挛的临床研究[J].临床和实验医学杂志,2017,16(8):768-771.
[4]江基尧,朱诚,罗其中.现代颅脑损伤学[M].2版.上海:第二军医大学出版社,2009:128-129.
[5]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[6] Pullicino P,Nelson RF,Kenall BE,et al. Small deep infarcts diagnosed on computed tomography[J]. Neurology,1980,30(10):1090-1096.
[7] Galbiati G,Paola C. Effects of open and closed endotracheal suctioning on intracranial pressure and cerebral perfusion pressure in adult patients with severe brain injury:A literature review[J]. J Neurosci Nurs,2015,47(4):239-246.
[8] Tamaki T,Node Y,Yamamoto Y,et al. Cardiopulmonary hemodynamic changes during acute subdural hematoma evaluation[J]. Neural Med Chir(Tokyo),2006,46(5):219-225.
[9] Gulburd JN,Sviri GE. Role of dural fenestrations in acute subdural hematoma[J]. J Neurosurg, 2013, 95(2):263-267.
[10]袁雪松,卞晓星,魏文峰,等.分步控制性减压术治疗重型脑外伤的临床应用[J].国际神经病学神经外科学杂志,2015,42(2):155-158.
[11]徐守仕,田福.逐步控制性减压手术治疗重型颅脑损伤的疗效分析[J].中国实用神经疾病杂志,2015,18(3):116-117.
[12]林其炎,何素娇,零达尚,等.老年颅脑损伤患者并发创伤性脑梗死的危险因素研究[J].实用心脑肺血管病杂志,2015,23(7):136-138.
[13]刘斌.中重度颅脑外伤患者继发急性外伤性脑梗死的危险因素和预后分析[J].安徽医药,2016,20(11):2104-2106.
[14]林岚.尼莫地平对重症颅脑损伤患者组织氧分压和血流动力学的影响[J].中国实用神经疾病杂志,2017,20(4):61-63.
[15]朱峰.早期应用尼莫地平对重度颅脑损伤患者血钠、血钾、血糖、C反应蛋白的影响及预防大面积脑梗塞的作用[J].海南医学院学报,2013,19(12):1665-1668.