重型颅脑外伤患者术后血压改变对脑梗死发生的影响研究

Effects of Postoperative Blood Pressure(BP) Change on Cerebral Infarction in Patients with Severe Crainocerebral Injury

目的探讨重型颅脑外伤患者术后血压变化对脑梗死发生的影响。方法重型颅脑外伤共196例,根据术后收缩压状况分为高压组(>160mmHg)69例、中压组(141～160mmHg)71例、低压组(<140mmHg)56例,高压组和中压组分别根据术后急性期内血压控制情况分为血压控制良好组和血压控制不良组,所有病例均采用常规去骨瓣开颅术清除血肿减压,术后早期行脱水治疗,术后1天、3天、7天复查CT。结果高压组患者31例(44.9%)出现脑梗死(死亡10例),血压控制良好组和血压控制不良组分别为11、20例,低压组患者18例(32.1%)出现脑梗死(死亡3例),其中血压控制良好组和血压控制不良组分别为6、12例,中压组患者17例出现脑梗死(23.9%)。结论重型颅脑外伤患者术后脑梗死发生率极高,术后急性期收缩压与此密切相关,早期合理使用脱水药物并适当扩容,严密监测血压状况,维持收缩压于141～160mmHg水平,保证有效脑灌注压,可显著减少此类患者脑梗死发生率,降低病死率。

Objective To observe the effects of postoperative blood pressure（BP） change on cerebral infarction in patients with severe crainocerebral injury. Methods 196 cases of severe crainoeerebral injury were divided into 3 groups according to their systolic blood pressure（SBP） levels ： 69 cases in high BP group（ 〉 160mmHg） , 71 cases in moderate BP group（ 141 - 160mmHg） , 56 cases in low BP group（ 〈 140mmHg）. High BP group and low BP group were divided into 2 subgroups： good BP control group and bad BP control group. After the operation of ordinary decompressive craniotomies to evacuate hematoma, all cases were treated by dehydrating agents. All cases underwent CT scanning at 1,3 and 7day after surgery. Results In high BP group, 31 patients（44.9% ） presented with cerebral infarction（ 10 cases dead） ,of whom 11 and 20 cases in good BP control group and bad BP control group respectirely. In low BP group, 18 patients（44.9% ） presented with cerebral infarction（3 cases dead） ,of whom 6 and 12 cases in good BP control group and bad BP control group respectirely. In moderate BP group, 17 cases （23.9%）presented with cerebral infarction. Conclusion The mortality of postoperative cerebral infarction of severe crainocerebral injury was extremely high, which was dosed relate to SBP. Appropriate use of dehydrating agents and volumic therapy, keeping SBP to a little high level（ 141 -160mmHg） to extend an effective erebral perfusion pressure can reduce the rate of cerebral infarction of severe crainocerebral injury patients effectively, also can decrease the mortality rate markly.