不同时间段行颅骨修补对脑血流动力学变化的影响

Influence of cranioplasty in different periods on hemodynamic change

目的探讨颅脑损伤去骨瓣减压术后不同时期行颅骨修补术对脑血流动力学的影响。方法回顾性分析2013年6月~2015年6月收治的50例颅脑损伤去骨瓣减压术后行颅骨修补患者的临床资料,根据修补时间分为早期组（〈12周,23例）和晚期组（≥12周,27例）。所有患者于术前1周和术后1周内行经颅多普勒超声测定脑血流速度,分析不同时间段行颅骨修补术后脑动脉血流速度的差异。结果早期颅骨修补组修补前后同侧大脑中动脉的血流速度分别为（55.3±8.4）cm/s、（72.6±9.7）cm/s,晚期颅骨修补组修补前后同侧大脑中动脉的血流速度分别为（54.7±12.9）cm/s、（63.2±13.4）cm/s,两组手术前的大脑中动脉血流速度比较,差异无统计学意义（P〉0.05）。早期组同侧的MCA血流速度改变量显著大于晚期组,差异有统计学意义（P〈0.05）。早期组和晚期组的缺损对侧MCA血流量比较,差异无统计学意义（P〉0.05）。结论去骨瓣减压患者早期行颅骨修补更有利于改善脑血流供应。

Objective To explore the influence of cranioplasty in different periods on hemodynamic changes after decompressive craniectomy due to cerebral trauma.Methods Clinical data from 50 patients underwent cranioplasty after decompressive craniectomy due to cerebral trauma from June 2013 to June 2015 in our hospital were retrospectively analyzed.All patients were divided into the early-stage group（less than 12 weeks,n=23） and the advanced-stage group（greater than or equal to 12 weeks,n =27） according to repair time.Cranial Doppler ultrasound determined for cerebral blood flow velocity one week before surgery and one week after surgery was provided in all participants.The difference of blood flow velocity of cerebral artery in different periods after cranioplasty was analyzed.Results In the early-stage group,blood flow velocity of middle cerebral artery in the same side before and after surgery was（55.3±8.4） cm/s and（72.6±9.7） cm/s,while the blood flow velocity in the advanced-stage group was（54.7 ±12.9） cm/s and（63.2±13.4） cm/s respectively,which was not displayed a statistical difference（P〉0.05）.The change amount of MCA blood flow velocity in the same side of the early-stage group was higher than that in the late-stage group,with significant difference（P〈0.05）.There was no significant difference in the defect contralateral MCA blood flow between the early-stage group and the late-stage group（P〉0.05）.Conclusion Cranioplasty in the early stage in decompressive craniectomy patients is more beneficial to improve cerebral blood supply.