姑息清创术治疗颅脑爆炸伤的实验研究

Less aggressive surgical approach in treatment of craniocerebral explosive injury in dogs

目的 :研究姑息清创术对颅脑爆炸伤动物的影响。 方法 :45条犬随机分为姑息清创组 ( 2 7条 )、彻底清创组 ( 13条 )和对照组 ( 5条 ) ,用完全随机研究方法观察比较两组清创动物伤后颅内感染和肢体麻痹的发生率 ,研究血浆内 TNF -α含量的动态变化。结果 :姑息清创组和彻底清创组动物颅内感染的发生率分别为 14 .8%和 15 .4% ,两组之间无显著差异 ( P>0 .0 5 )。而姑息清创组动物肢体麻痹的发生率为 2 5 .9% ,明显低于彻底清创组 6 9.2 % ( P<0 .0 1)。清创术后不同时相点实验组动物血浆中 TNF -α含量均明显高于对照组 ( P<0 .0 1) ,姑息清创组和彻底清创组动物血浆中 TNF -α含量无显著差异 ( P>0 .0 5 )。结论 :姑息清创术颅内遗留碎片没有明显增加颅内感染的发生率 ,但本术式可减少肢体麻痹的发生率 ,提示其可改善颅脑爆炸伤动物的生存质量。

Objective: To evaluate the effect of less aggressive surgical approach on the craniocerebral explosive injury. Methods: Fifty five dogs were assigned to control group and experiment group which were randomly divided into less aggressive and aggressive surgical group. The intracranial infection rate and morbidity of limb paralysis were observed, the dynamic changes of plasma TNF α were detected. Results: In the less aggressive surgical group, intracranial infection rate was 14.8%, there were no significant differences compared with aggressive surgical group ( P >0.05). Limb paralysis occurred in 7 dogs(25.9%) in the less aggressive surgical group and 69.2% in aggressive surgical group( P <0.01). Higher plasma levels of TNF α were observed in experiment group than that of normal controls( P <0.01), there were no significant variation between the 2 experiment groups ( P >0.05). Conclusion: There is no relationship between the presence of retained fragments and development of the central nervous system infection. It is unnecessary to reoperate for retained bone fragments, but it may temper the initial debridement in an effort to preserve additional cerebral tissue.