河北医学2018，Vol.24Issue(5)：725-730,6.DOI:10.3969/j.issn.1006-6233.2018.05.006
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
Effect of Standard Large Trauma Craniotomy combined with Vascular Reconstruction for Severe Traumatic Brain Injury and the Influence on Cerebral Perfusion
摘要
Abstract
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. Meth-ods: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 in-to 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 revas-cularization.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 sugery 7D 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 sig-nificantly 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) mmHg vs(21.40 ±1.94) mmHg,(64.98±7.30) mmHg vs(57.54 ±6.19) mmHg]. There was no significant difference in the incidence of intracranial infection, epilepsy, hy-drocephalus 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 cere-bral perfusion,and have less postoperative complications and high prognosis. It is worthy of application.关键词
重型颅脑损伤/标准大骨瓣减压术/血管重建术/脑灌注Key words
Severe craniocerebral injury/Standard large bone flap decompression/Revascular-ization/Cerebral perfusion引用本文复制引用
朱世佳,吴世强,范小红,李秀云..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[J].河北医学,2018,24(5):725-730,6.基金项目
广东省医学科研基金立项项目,(编号:A2009716) （编号:A2009716）
