高灌注疗法联合法舒地尔、前列地尔在重型颅脑外伤术后脑梗死的应用

Application of high perfusion therapy combined with fasudil and prostaglanddin E1 in patents with cerebral infarction after receiving surgery for severe traumatic brain injury

目的 探讨重型颅脑外伤并脑疝形成患者行开颅大骨瓣减压术后外伤性脑梗死的治疗。方法 揭阳市人民医院神经外一区自2009年1月至2012年4月对32例重型颅脑外伤、脑疝行开颅大骨瓣减压术后合并外伤性脑梗死患者，在补足血容量情况下应用少量升压药持续高灌注并联合法舒地尔、前列地尔扩血管解痉治疗，回顾性分析患者的临床资料和疗效。结果 本组患者治疗后复查CT证实梗死灶均消失，脑组织恢复良好，其中治愈17例，恢复良好12例，轻度残疾2例，重残1例，未出现植物生存及死亡病例。结论 在补足血容量前提下应用少量升压药持续高灌注联合法舒地尔、前列地尔扩血管解痉治疗重型颅脑外伤并脑疝形成患者术后的外伤性脑梗死．疗效显著，经济实惠，值得推广。

Objective To investigate the traumatic cerebral infarction treatment m patients warn severe craniocerebral trauma combined with cerebral hernia after performing large decompressive craniectomy. Methods Thirty-two patients with cerebral infarction after receiving decompressive craniectomy for severe traumatic brain injury combined with brain hernia, admitted to our hospital from January 2009 to April 2012, were chosen in our study; these patients were given saline （35 mL） ＋dopamine （100 mg）＋Aramine （50 mg） micro-pump infusion for 2-3 mL/h, 24 hours of high perfusion combined with fasudil and prostaglanddin E1 for antispasmodic therapy. The clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Postoperative head CT confirmed the disappearance of infarction focuses and good recovery of brain tissues, including cure in 17 patients, good recovery in 12, mild disability and severe disability in I; no persistent vegetative state or death were noted. Conclusion Under the premise of full blood volume, high perfusion combined with fasudil and prostaglanddin E1 for antispasmodic treatment enjoys good effect in patients with severe craniocerebral trauma combined with cerebral hernia after performing large decompressive craniectomy, which is economical, practical, and worthy to be popularized.