摘要
目的探讨早期颅骨修补对重型颅脑损伤(STBI)去骨瓣减压术(DC)后患者脑血流动力学的影响。方法选取220例2018年6月-2020年11月本院收治的DC术后STBI患者作为研究对象,根据随机数字表法分为试验组(110例)、对照组(110例)。对照组DC术后晚期(3-6个月)行颅骨修补术,试验组DC术后早期(3个月内)行颅骨修补术,两组术后均随访3个月。对比两组术前、术后3个月的预后情况,术前、术后14d大脑中动脉(MCA)的平均血流速度(Vm)、日常生活活动能力、基底节区及大脑皮层血流动力学参数变化。结果术后3个月,两组格拉斯哥预后量表(GOS)、格拉斯哥昏迷指数量表(GCS)评分均高于术前,且试验组高于对照组(P<0.05);而两组神经功能评分低于术前,且试验组低于对照组(P<0.05)。术后14 d,两组患侧MCA的Vm水平、Barthel指数(BI)评分、基底节区与大脑皮层脑血流容量(CBV)及脑血流流量(CBF)均高于术前,且试验组高于对照组(P<0.05);两组基底节区、大脑皮层对比剂峰值时间(TTP)值低于术前,且试验组低于对照组(P<0.05);两组健侧MCA的Vm水平均高于术前(P<0.05),但两组间对比无统计学差异(P>0.05);两组基底节区与大脑皮层对比剂通过时间(MMT)值均低于术前(P<0.05),但两组间对比无统计学差异(P>0.05)。结论对于DC术后STBI患者,如术后颅内压控制良好、脑水肿消退及无感染者,早期行颅骨修补较为安全可行,有利于改善患者脑血流动力学,促进神经功能恢复,进而可提高其日常生活活动能力,改善预后。
Objective To explore the effect of early skull repair on the cerebral hemodynamics of patients with severe traumatic brain injury(STBI)after decompressive craniectomy(DC).Methods A total of 220 patients with STBI after DC who were admitted to our hospital from June 2018 to November 2020 were selected as the research objects.They were divided into the test group(110 cases)and the control group(110 cases)according to the random number table method.The control group underwent skull repair at the late postoperative period(3-6 months)after DC operation,and the test group underwent skull repair at the early postoperative period(within 3 months)after DC operation.Both groups were followed up for 3 months after operation.The prognosis of the two groups before and 3 months after the operation were compared.The average blood flow velocity(Vm)of the middle cerebral artery(MCA),activities of daily living,blood flow in the basal ganglia and cerebral cortex before and 14 d after the operation were compared.Results 3 months after operation,the scores of Glasgow outcome scale(GOS)and Glasgow coma index(GCS)of the two groups were higher than those before the operation,and the test group was higher than the control group(P<0.05);the score of nerve function of the two groups were lower than that before the operation,and the test group was lower than the control group(P<0.05).14 d after operation,the Vmlevel of the MCA,the score of Barthel index(BI),cerebral blood flow volume(CBV)and cerebral blood flow(CBF)of the basal ganglia and cerebral cortex of the two groups were higher than those before the operation,and the test group was higher than the control group(P<0.05);the basal ganglia and cerebral cortex contrast medium peak time(TTP)value was lower than before the operation,and the test group was lower than the control group(P<0.05);the Vm levels of the contralateral MCA of the two groups were higher than before the operation(P<0.05),but there was no statistical difference between the groups(P>0.05);the contrast agent passage time(MMT)values of the basal ganglia and cerebral cortex of the two groups were lower than those before the operation(P<0.05),but there was no statistical difference between the groups(P>0.05).Conclusion For patients with STBI after DC,if the intracranial pressure was well controlled,the cerebral edema has subsided,and there was no infection,early skull repair was safer and feasible,which was beneficial to improve the patient's cerebral hemodynamic status,promote the recovery of nerve function,improve its activities of daily living,and could improve the prognosis.
作者
张磊
ZHANG Lei(Friendship Hospital of Urumqi,Urumqi,830049,China)
出处
《新疆医学》
2023年第6期682-686,共5页
Xinjiang Medical Journal