高血压脑出血去骨瓣减压术后不同时期行三维钛网修补术的效果分析

Analysis of the effect of three-dimensional titanium mesh repair at different stages after decompression of craniectomy for intracerebral hemorrhage

目的探讨高血压脑出血患者去骨瓣减压术后不同时期行三维钛网修补术对脑灌注、颅内压及神经功能的影响.方法选择济南市第五人民医院2015年10月至2018年10月收治的行去骨瓣减压术的高血压脑出血患者132例,采用双盲随机法分为观察组、对照组各66例,观察组去骨瓣减压术后24~42 d行三维钛网修补术,对照组术后90~150 d(3~5个月)行三维钛网修补术.比较两组患者手术情况、脑灌注、颅内压及神经功能.结果观察组手术时间、失血量及皮瓣游离时间分别为(92.5±12.4)min、(354.3±17.5)mL、(13.2±3.1)min,均短于、少于对照组的(142.8±15.3)min、(518.3±22.3)mL、(38.3±4.3)min,两组差异均有统计学意义(t=4.745、6.831、4.963,均P<0.05);观察组颅内压异常指数、脑灌注异常指数分别为(0.1±0.0)、(0.2±0.1),对照组分别为(0.2±0.1)、(0.3±0.1),观察组均低于对照组(t=3.657、2.579,均P<0.05);两组不同时间点神经功能缺损评分差异均有统计学意义(均P<0.05);观察组并发症发生率为10.9%(7/64),显著低于对照组的38.7%(24/62)(x2=14.094,P<0.05).结论高血压脑出血患者去骨瓣减压术后超早期行三维钛网修补术,有助于缩短手术时间,恢复患侧颅内压,改善患者脑灌注,减轻神经功能损害程度,其疗效较晚期行三维钛网修补术更佳.

Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People zs Hospital of Jinan were selected and divided into observation group(66 cases)and control group(66 cases)by double blind random method.The observation group received three-dimensional titanium mesh repair at 24~42 d after bone disc decompression surgery.The control group received three一dimensional titanium mesh repair at 90~150 d(3~5 months)after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were(92.5±12.4)min,(354.3±17.5)mL and(13.2±3.1)min,respectively,which were shorter or less than those in the control group[(142.8±15.3)min,(518.3±22.3)mL and(38.3±4.3)niin],the differences between the two groups were statistically significant(i=4.745,6.831,4.963,all P<0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were(0.1±0.0)and(0.2±0.1),respectively,which were lower than those in the control group[(0.2±0.1),(0.3±0.1)](t=3.657,2.579,all P<0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P<0.05).The incidence of treatment complications in the observation group was 10.94%(7/64),which was significantly lower than that in the control group[38.7%(24/62)](x2=14.094,P<0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.