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

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(论文5400字)
【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，观察组预后良好率为66.67%（30/45），明显高于对照组的40.00%（18/45）（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。
【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

Curative efficacy of standard large bone flap decompression combined with revascularization in treatment of severe craniocerebral injury and its effects on cerebral perfusion
[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. Methods 90 patients of severe craniocerebral injury who received therapy fromJanuary 2014 to January 2017 in our hospital were selected as research objects. According to random number table，those 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 After surgery 7d, the whole blood viscosity, whole blood viscosity, plasma viscosity and hematocrit of two groups were significantly lower than those before surgery(P＜0.05), the whole blood viscosity, whole blood viscosity, plasma viscosity and hematocrit in the observation group were significantly lower than those in the control group(P＜0.05); after surgery 7d, the prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time (TT) of two groups were significantly higher than those before operation(P＜0.05), the PT, APPT and TT in the observation group were significantly higher than those in the control group(P＜0.05); after surgery 7d, the ICP of two groups was significantly lower than those before operation, and the CCP was significantly increased(P＜0.05), the ICP in the observation group was significantly lower than those in the control group, and the CCP was significantly higher than those in 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] (P＜0.05); there was no significant difference in the incidence of intracranial infection, epilepsy, hydrocephalus and incisional hernia between the two groups(P＞0.05); after surgery 6 months, the good prognosis rate in the observation group was 66.67% (30/45), which was significantly higher than those in the control group 40.00%(18/45)(P＜0.05). Conclusion Standard large bone flap decompression combined with revascularization is well for severe craniocerebral injury, which can effectively improve blood rheology and coagulation function, promote cerebral perfusion, and has less postoperative complications and higher prognosis, it’s worthy of popularization and application.
[Key words] Severe craniocerebral injury; Standard large bone flap decompression; Revascularization; Cerebral perfusion