一侧大脑损伤患者两侧半球压力梯度的变化

Gradient changes of bilateral cerebral hemisphere pressure in patients with lateral hemisphere injury

目的了解一侧大脑损伤后两侧半球压力梯度的变化及开颅手术的影响。方法选择24例一侧大脑额、颞叶脑挫伤、硬膜下脑内血肿的患者，CT显示伤侧有占位效应、中线向对侧移位。入院后即分别于两侧额部钻颅置入光导纤维传感器行两侧大脑半球脑组织压（BPP）监护，所有患者都接受开颅血肿清除手术。分别于术前、术后收集两侧大脑半球BPP数据，并行配对分析。结果术前监测的两侧BPP差异有统计学意义（P〈0．01）。术后当时、术后24h、48h监测的两侧BPP差异均无统计学意义（P〉0．05）。患者手术后的两侧脑组织压力均比手术前明显下降。结论为及时掌握颅内准确信息，BPP监护传感器应放置于伤侧大脑半球为宜。当一侧大脑损伤、出血时，伤侧大脑半球便成为颅内压增高的源头，并与对侧大脑半球形成了压力梯度。开颅血肿清除手术不但有效降低了颅内压，还消除了两侧大脑半球的压力梯度，移位的脑组织能得以复位。

Objective To investigate the gradient changes of bilateral cerebral hemisphere pressure after lateral hemisphere injury and observe their effects on craniotomy. Methods Twenty-four patients with cerebral contusion and subdural intracerebral hematoma were included in this study. All patients received brain parenchyma pressure （BPP） monitoring by introducing optic fibro sensor into each cerebral hemisphere via the frontal lobe. All patients underwent surgical craniotomy for evacuation of space occupying lesions such as cerebral hemisphere contusion, subdural and/or intracerebral hematoma. Preoperative and postoperative BPP data at different time points were reeorded and analyzed. Results Preoperative BPP value of the injured hemispheres was significantly higher than that of the other hemisphere （P 〈0.01 ）. There was no significant statistical difference upon BPP value at 0, 24 and 48 hours after operation between both hemispheres （ P 〉 0.05 ）. The postoperative BPP value of bilateral hemispheres was lower than the preoperative one. Conclusions BPP monitoring sensors should be introduced into the injured hemisphere so that the valuable information can be timely showed. When the cerebral hemisphere has lesions after brain injury, such lesion becomes the source of elevated intracranial pressure and can result in bilateral hemisphere pressure gradient. Craniotomy can not only effectively lower the intracranial pressure, but also eliminate the BPP gradient, which contritbutes to reposition of the oppressed brain tissue.