标准大骨瓣减压术联合血管重建术治疗重型颅脑损伤的疗效及对脑灌注的影响
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摘要
目的:探讨标准大骨瓣减压术联合血管重建术治疗重型颅脑损伤的疗效及对脑灌注的影响。方法:选择2014年1月至2017年1月我院接诊的90例重型颅脑损伤患者进行研究,通过随机数表法分为观察组(n=45)和对照组(n=45),对照组使用标准大骨瓣减压术治疗,观察组联合脑-硬脑膜-肌肉血管重建术治疗。比较两组血液流变学、凝血功能、颅内压(ICP)、脑灌注量(CCP)、术后并发症及预后。结果:手术后7d,两组全血高切粘度、全血低切粘度、血浆粘度、红细胞压积较手术前均显著降低(P<0.05),观察组两组全血高切粘度、全血低切粘度、血浆粘度、红细胞压积均明显比对照组低(P<0.05);手术后7d,两组凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶原时间(TT)较手术前均显著升高(P<0.05),观察组PT、APPT、TT明显高于对照组(P<0.05);手术后7d,两组ICP较手术前均显著降低,CCP显著升高(P<0.05),观察组ICP明显低于对照组,CCP明显比对照组高[(16.31±1.70)mmHg vs(21.40±1.94)mmHg,(64.98±7.30)mmHg vs(57.54±6.19)mmHg](P<0.05);两组颅内感染、癫痫、脑积水、切口疝发生率比较均无显著差异(P>0.05);术后6个月时,观察组预后明显对照组优于对照组(P<0.05)。结论:在重型颅脑损伤患者中使用标准大骨瓣减压术联合血管重建术效果显著,可有效改善血液流变学和凝血功能,促进脑灌注,且术后并发症少、预后高,值得应用推广。
Objective: To study the curative efficacy of standard large bone flap decompression combined with revascularization in treatment of severe craniocerebral injury and its effects on cerebral perfusion. Methods: 90 patients of severe craniocerebral injury who received therapy from January 2014 to January 2017 in our hospital were selected as research objects. According to random number table,all the patients were divided into the observation group( n = 45) and the control group( n = 45),the control group was treated with standard large bone flap decompression,while the observation group was combined with brain-duramater-muscle revascularization. The blood rheology,coagulation function,intracranial pressure( ICP),cerebral perfusion volume( CCP),postoperative complications and prognosis were compared between the two groups. Results: The blood viscosity,whole blood low shear viscosity,plasma viscosity and hematocrit of the two groups after sugery7 D were significantly lower than those before operation( P < 0.05). On 7 days after operation,the two groups were significantly lower in whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity and hematocrit than before operation( P < 0.05). On 7 days after operation,ICP of the two groups were significantly lower than those before the operation,and the CCP was significantly higher( P < 0.05). The ICP in the observation group was significantly lower than the control group,and the CCP was significantly higher than that of the control group [( 16.31 + 1.70) mm Hg vs( 21.40 ±1.94) mm Hg,( 64.98±7.30) mm Hg vs( 57.54±6.19) mm Hg]. There was no significant difference in the incidence of intracranial infection,epilepsy,hydrocephalus and incisional hernia between the two groups( P > 0.05). 6 months after operation,the prognosis in the observation group was significantly better than that in the control group( P < 0.05). Conclusion: The use of standard large bone flap decompression and vascular reconstruction in patients with severe craniocerebral injury has significant effect. It can effectively improve blood rheology and coagulation function,promote cerebral perfusion,and have less postoperative complications and high prognosis. It is worthy of application.
Objective: To study the curative efficacy of standard large bone flap decompression combined with revascularization in treatment of severe craniocerebral injury and its effects on cerebral perfusion. Methods: 90 patients of severe craniocerebral injury who received therapy from January 2014 to January 2017 in our hospital were selected as research objects. According to random number table,all the patients were divided into the observation group( n = 45) and the control group( n = 45),the control group was treated with standard large bone flap decompression,while the observation group was combined with brain-duramater-muscle revascularization. The blood rheology,coagulation function,intracranial pressure( ICP),cerebral perfusion volume( CCP),postoperative complications and prognosis were compared between the two groups. Results: The blood viscosity,whole blood low shear viscosity,plasma viscosity and hematocrit of the two groups after sugery7 D were significantly lower than those before operation( P < 0.05). On 7 days after operation,the two groups were significantly lower in whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity and hematocrit than before operation( P < 0.05). On 7 days after operation,ICP of the two groups were significantly lower than those before the operation,and the CCP was significantly higher( P < 0.05). The ICP in the observation group was significantly lower than the control group,and the CCP was significantly higher than that of the control group [( 16.31 + 1.70) mm Hg vs( 21.40 ±1.94) mm Hg,( 64.98±7.30) mm Hg vs( 57.54±6.19) mm Hg]. There was no significant difference in the incidence of intracranial infection,epilepsy,hydrocephalus and incisional hernia between the two groups( P > 0.05). 6 months after operation,the prognosis in the observation group was significantly better than that in the control group( P < 0.05). Conclusion: The use of standard large bone flap decompression and vascular reconstruction in patients with severe craniocerebral injury has significant effect. It can effectively improve blood rheology and coagulation function,promote cerebral perfusion,and have less postoperative complications and high prognosis. It is worthy of application.
引文
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[2]Brown CVR,Rix K,Klein AL,et al.A Comprehensive investigation of comorbidities,mechanisms,injury patterns,and outcomes in geriatric blunt trauma patients[J].Am Surg,2016,82(11):1055~1062.
[3]Hopp S,Albert-Weissenberger C,Mencl S,et al.Targeting coagulation factor XⅡas a novel therapeutic option in brain trauma[J].Ann Neurol,2016,79(6):970~982.
[4]Kazumata K,Kamiyama H,Saito H,et al.Direct anastomosis using occipital artery for additional revascularization in moyamoya disease after combined superficial temporal artery-middle cerebral artery and indirect bypass[J].Oper Neurosurg(Hagerstown),2017,13(2):213~223.
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[8]Gupta D,Singla R,Mazzeo AT,et al.Detection of metabolic pattern following decompressive craniectomy in severe traumatic brain injury:A microdialysis study[J].Brain Inj,2017,31(12):1660~1666.
[9]Mozgovoi PV,Spiridonov EG,Mandrikov VV,et al.First experience with total laparoscopic reconstructive operations in occlusive lesion of the aortoiliac arterial segment[J].Angiol Sosud Khir,2017,23(1):175~180.
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[11]Liu J,Tian HL.Relationship between trauma-induced coagulopathy and progressive hemorrhagic injury in patients with traumatic brain injury[J].Chin Traumatol,2016,19(3):172~175.
[12]黄良珍,刘朝晖,彭浩,等.去骨瓣减压联合血管重建术对重型颅脑损伤患者脑灌注的影响[J].解放军医学杂志,2015,40(11):934~937.