颅脑损伤去骨瓣减压患者亚急性期脑血流的动态变化

Cerebral hemodynamic changes during subacute stage after undergoing decompressive craniectomy for traumatic brain injury

目的了解颅脑损伤去骨瓣减压患者术后亚急性期脑血流动力学的变化规律，为合理的临床治疗提供依据。方法前瞻性地选择开颅去骨瓣减压的创伤性颅脑损伤患者68例，根据患者术前GCS评分，将患者分为轻、中和重型组，术后第1、2周和第3周末进行经颅多普勒（TCD）检测，在较长的时期内动态了解该类患者术后脑血流动力学的变化情况。结果（1）同一时期组间比较脑血管痉挛的发生率，发现中、重型脑损伤组较高，与轻型组相比有统计学意义（P〈0．05、P〈0．01）；（2）脑血管供血不足的发生率为6％～35％，同一时期组间比较，中、重组的发生率高，有统计学意义（P〈0．05）。结论脑损伤开颅去骨瓣减压术后亚急性期存在脑血流动力学的改变，脑血管痉挛和供血不足在较严重的脑损伤患者常见，TCD可以动态、无创地了解脑血流动力学的变化情况，指导临床治疗。

Objective To explore the rule of hemodynamic changes during subacute stage after undergoing decompressive craniectomy for traumatic brain injury so as to treat them more reasonably in clinic. Methods 68 cases of traumatic brain in- jury patients were prospectively selected,who had undergone decompressive craniectomy and were divided into mild,moderate and severe groups. The transcranial Doppler{ TCD ） ultrasonography measurements were performed bilaterally in the middle cer- ebral artery（MCA） ,the anterior cerebral artery（ACA）, the basal artery（ BA） and the vertebral artery（ VA ） on the first, the second and the third weekend after operation. Results （ 1 ） More hemodynamically significant vasospasm was found in moderate and severe groups at the same time than the mild group （ P 〈 0.05 ,P 〈 0.01 ） ; （ 2 ） The incidence of cerebral artery flow in- sufficiency in the study was 6% ~ 35%, and it was noted that the more severe the cerebral injury, the more frequent the cere- bral artery flow insufficiency （P 〈 0. 05 ）. Conclusion Transcranial Doppler{ TCD） ultrasonography is an effective, noninva- sive method for the detection of cerebral hemodynamic change during the subacute stage after undergoing decompressive crani- ectomy for traumatic brain injury,and it is meaningful for a more reasonable freatment in clinic.