颅骨修补术对皮瓣塌陷综合征患者脑血流及神经认知功能的影响

Effect of Skull Repair on Cerebral Blood Flow and Neurocognitive Function in Patients with Flap Collapse Syndrome

[目的]探讨颅骨修补术对皮瓣塌陷综合征(SSFS)患者脑血流、脑电图及神经认知功能的影响.[方法]回顾性分析56例行颅骨修补术经颅多普勒(TCD)监测的SSFS患者的临床资料.监测术前1 d及术后1个月患者双侧大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)的收缩期峰流速(PSV)、舒张期峰流速(EDV)和平均血流速度(M V)的变化;比较手术前后脑电图(EEG)异常发生率及神经认知功能(FIM评分)改善情况.[结果]SSFS患者术前患侧ACA、MCA及PCA的PSV、EDV、M V均低于健侧,术后患侧ACA、MCA及PCA的PSV、EDV、MV均高于术前,差异均有统计学意义(P<0.05).SSFS患者术前FIM评分为(98.21±5.54)分,低于术后的(112.36±3.86)分,差异有统计学意义(P<0.05).术后EEG总异常率为41.1%(23/56),低于术前的46.4%(26/56),但差异无统计学意义(P=0.063>0.05).[结论]颅骨修补术能改善SSFS患者脑血流状态和较好的改善患者术后神经认知功能.

[Objective]To explore the effect of cranioplasty on cerebral blood flow,EEG and neurocognitive function in patients with skin flap collapse syndrome(SSFs).[Methods]The clinical data of 56 patients with SSFs monitored by TCD were analyzed retrospectively.The changes of systolic peak velocity(PSV),diastolic peak velocity(EDV)and mean blood flow velocity(MV)of bilateral anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)were monitored on the day before and one month after operation,and the abnormal rate of EEG and the improvement of neurocognitive function(FIM)before and after operation were compared.[Results]The PSV、EDV、MV of ACA、MCA and PCA of affected side were lower than that of healthy side before operation,and the PSV、EDV、MV of ACA、MCA and PCA were higher than that before operation,the difference was statistically significant(P<0.05).SSFS preoperative FIM score(98.21 i t 5.54)was lower than postoperative(112.36 zh 3.86),and the difference was statistically significant(P<0.05).The total abnormal rate of postoperative EEG was 41.1%(23/56))which was lower than that of preoperative 46.4%(26/56),but the difference was not statistically significant(P=0.0630.05).[Conclusion]Skull repair can improve cerebral blood flow status and improve postoperative neurocognitive function in SSFS patients.