脑-硬脑膜-肌肉血管重建联合标准大骨瓣减压术治疗重型颅脑损伤临床观察

Encepho-duro-myo-synangiosis combined with standard large trauma craniotomy in treatment of severe traumatic brain injury

目的观察脑-硬脑膜-肌肉血管重建联合标准大骨瓣减压术治疗重型颅脑损伤(STBI)的临床疗效.方法选择本院2017年10月至2018年9月治疗的126例STBI患者,通过随机数表法将其分为两组,各63例.对照组行标准大骨瓣减压术,观察组在此基础上加用脑-硬脑膜-肌肉血管重建术.观察两组手术前后血液流变学指标[全血高切黏度(HBV)、全血低切黏度(LBV)]、脑灌注情况[脑灌注量(CCP)、颅内压(ICP)]及并发症.结果术前,两组患者HBV、LBV、CCP、ICP水平比较,差异均无统计学意义(均P>0.05);术后,观察组HBV、LBV、ICP水平分别为(3.76±0.92)mPa·s、(7.23±1.18)mPa·s、(16.22±1.73) mmHg,均低于对照组,CCP水平(66.94±7.50) mmHg,高于对照组,差异均有统计学意义(均P< 0.05);观察组并发症发生率9.52%与对照组12.70%比较,差异无统计学意义(P>0.05).结论脑-硬脑膜-肌肉血管重建、标准大骨瓣减压术联合使用有助于降低STBI患者颅内压,改善脑灌注及血液流变学,且术后并发症少.

Objective To observe the clinical efficacy ofencepho-duro-myo-synangiosis combined with standard large trauma craniotomy in the treatment of severe traumatic brain injury (STBI).Methods 126 patients with STBI treated at our hospital from October,2017 to September,2018 were selected,and were divided into a control group and an observation group by random number table,63 cases for each group.The control group were treated with standard large trauma craniotomy;in addition,the observation group were treated with encephoduro-myo-synangiosis.The hemorheological indicators [high blood viscosity (HBV) and low blood viscosity (LBV)],cerebral perfusion [critical closing pressure (CCP),intracranial pressure (ICP)],and complications in the two groups before and after the surgery were observed.Results Before the surgery,there were no statistical differences in the levels of HBV,LBV,CCP,and ICP between the two groups (all P > 0.05).After the surgery,compared with those in the control group,the HBV,LBV,and ICP in the observation group [(3.76±0.92)mPa·s,(7.23±1.18)mPa·s,(16.22±1.73)mmHg] were lower,while the CCP in observation group [(66.94±7.50)mmHg] was higher (all P < 0.05).There was no statistical difference in the incidence of complications between the observation group and the control group (9.52% vs.12.70%,P > 0.05).Conclusion Encepho-duro-myo-synangiosis combined with standard large trauma craniotomy in the treatment of patients with STBI can decrease ICP and improve cerebral perfusion and hemorheology,and have fewer postoperative complications.