不同术式对重型颅脑损伤患者血小板活化指标及脑血管痉挛状态的影响观察

Influence of different surgical methods on platelet activation indicators and cerebral angiospasm status of patients with severe craniocerebral injury

目的观察标准大骨瓣开颅术与小骨窗开颅术对重型颅脑损伤患者血小板活化指标、脑血管痉挛状态的影响。方法选取2012年5月～2013年6月收治的重型颅脑损伤患者89例，根据所用的不同术式分为小骨窗组（小骨窗开颅术44例）与大骨瓣组（标准大骨瓣开颅术45例），观察不同术式对血小板活化指标、脑血管痉挛状态的影响。结果两组术后均不同程度提高血小板活化指标水平（CD62p、CD63、GPⅡb／Ⅲa、PAgT），但大骨瓣组治疗后血小板活化指标水平明显低于小骨窗组（P〈0．05或P〈0．01）；大骨瓣组脑血管痉挛发生率6．67％（3／45）明显低于小骨窗组22．73％（10144）（P〈0．05）。结论对重型颅脑损伤患者应用标准大骨瓣开颅术治疗，能有效降低血小板活化指标，改善脑血管痉挛，相比小骨窗开颅术具有更为理想的临床效果，值得临床对手术方式和手术效果继续探讨。

Objective To observe the influences of standard large trauma craniotomy and small bone window craniotomy on the platelet activation indicators and cerebral angiospasm status of the patients with severe craniocerebral injury. Methods Eighty-nine patients with severe eraniocerebral injury treated in our hospital from May 2012 to June 2013 were selected and divided into the small bone window craniotomy group（included 44 patients receiving small bone win- dow craniotomy） and the large trauma craniotomy group （included 45 patients receiving standard large trauma craniotomy）. The influences of different surgical methods on the platelet activation indicators and cerebral angiospasm status of the patients with severe cranioeerebral injury were observed. Results The levels of postoperative platelet activation in- dicators of both groups increased to varying degrees （CD62p, CD63, GP 11 b/m a, PAgT）, but the postoperative platelet activation indicator level of the large trauma eraniotomy group was significantly lower than that of the small bone window craniotomy group （P〈0.05 or P〈0.01 ）. The incidence of cerebral angiospasm of the large trauma eranioto- my group was 6.67% （3/45）, which was significantly lower than the 22.73% （10/44） of the small bone window eraniotomy group （P〈0.05）. Conclusion The application of standard large trauma eraniotomy in the patients with severe cranioeerebral injury can effectively reduce the platelet activation indicators and improve the cerebral angiospasm, and have more ideal clinical effects than small bone window craniotomy, thereby worthy of further clinical exploration of surgical procedures and surgical effects.