手术时间窗与长春西汀对预防外伤性脑疝术后枕叶梗死的影响

Effects of operative time window and vinpocetine on preventing occipital lobe infarction after traumatic cerebral herniation surgery

目的探讨手术时间窗与长春西汀对预防外伤性脑疝术后枕叶梗死的影响。方法回顾性分析125例外伤性小脑幕切迹疝行手术治疗病人的临床资料,根据不同手术时间窗及是否运用长春西汀分为4组:≤3 h治疗组27例,≤3 h对照组26例,>3 h治疗组36例,>3 h对照组36例;统计分析4组术后出现枕叶梗死的情况。结果≤3 h治疗组枕叶梗死发生率最低,>3 h对照组最高,4组间枕叶梗死发生率差异显著(P<0.01);其中进一步分析显示:两治疗组术后3 d后枕叶梗死发生率均明显低于两对照组(P<0.05)。4组病人住院时间差异显著(P<0.05),≤3 h治疗组的住院时间最短。结论外伤性脑疝病人3 h内手术,并在术后3 d结合使用长春西汀,可改善大脑后动脉血供,显著降低脑疝术后枕叶梗死的发生率。

Objective To investigate the effects of different operative time window and whether using vinpocetine on preventing the occipital lobe infarction after traumatic cerebral herniation surgery. Methods Clinical data of 125 patients with traumatic tentorial incisura herniation undergoing surgery were analyzed retrospectively. The patients were divided into 4 groups according to the different operative time windows and whether using vinpocetine, including ≤3-h treatment group with 27 patients,≤3-h control group with 26,>3-h treatment group with 36 and >3-h control group with 36. Postoperative occipital lobe infarction was analyzed statistically in the 4 groups. Results There was a significant difference in the incidence rate of occipital lobe infarction between the 4 groups(P<0.01), with the lowest rate in the ≤3-h treatment group and the highest in the >3-h control group. Further analysis showed that the incidence rate of occipital lobe infarction after 3 days in the two treatment groups was significantly lower than that in the two control groups(P<0.05). The lengths of stay were significantly different between the 4 groups(P<0.05), with the shortest length in the ≤3-h treatment group. Conclusions The operation within 3-h can relieve the compression of the posterior cerebral artery, and combination with use of vinpocetine on 3 d after the operation can improve the blood supply of the posterior cerebral artery and significantly reduce the incidence rate of occipital lobe infarction after surgery in the patients with traumatic cerebral herniation.