单侧开颅手术中采取控制减压技术对对冲性颅脑损伤患者脑灌注压的影响

Effects of Controlled Decompression Technology on Cerebral Perfusion Pressure in Patients with Contrecoup Craniocerebral Injury during Unilateral Craniotomy

目的:探讨单侧开颅手术中采取控制减压技术对对冲性颅脑损伤患者脑灌注压的影响。方法:选取2018年7月至2022年4月于医院接受单侧开颅手术治疗的100例对冲性颅脑损伤患者,按照随机数字表法分为对照组与研究组,各50例。对照组术中采用常规减压技术,研究组术中采用控制减压技术。比较两组术中脑膨出发生情况、美国国立卫生院神经功能缺损评分(NIHSS)、颅内压、脑灌注压、生活质量测定量表简表(WHOQOL-BREF)评分、并发症及预后情况。结果:研究组术中脑膨出发生率低于对照组(P<0.05);术后7 d两组NIHSS评分、颅内压均显著降低,脑灌注压均显著升高,且研究组NIHSS评分、颅内压更低,脑灌注压更高(P<0.05);术后3个月两组WHOQOL-BREF各项评分均显著升高,且研究组更高(P<0.05);研究组并发症发生率低于对照组(P<0.05);术后3个月,研究组预后情况显著优于对照组(P<0.05)。结论:单侧开颅手术中采取控制减压技术可有效促进对冲性颅脑损伤患者神经功能恢复,减少术中脑膨出的发生,调节颅内压和脑灌注压,减少并发症,有助于术后恢复,促进生活质量提升,改善预后。

Objective:To study the effects of controlled decompression technology on cerebral perfusion pressure in patients with contrecoup craniocerebral injury during unilateral craniotomy.Methods:From July 2018 to April 2022,100 patients with contrecoup craniocerebral injury who received unilateral craniotomy in the hospital were selected and divided into a contrlo group and a study group according to the random number table method,each with 50 patients.The control group used conventional decompression technique,while the study group used controlled decompression technique.The incidence of intraoperative encephalocele,National Institutes of Health Neurological Deficiency Score(NIHSS),intracranial pressure,cerebral perfusion pressure,World Health Organization on Quality of Life Brief Scale(WHOQOL-BREF) score,complications and prognosis were compared between the two groups.Results:The incidence of intraoperative encephalocele in the study groupwas lower than that in the control group(P<0.05).On the 7th day after operation,the NIHSS score and intracranial pressure in both groups were significantly decreased,and the study group were lower than those in the control group;while the cerebral perfusion pressure in both group was significantly increased,and the study group was higher than that in the control group(P<0.05).Three months after operation,WHOQOL-BREF scores in both groups increased significantly,and WHOQOL-BREF score in the study group was higher than that in the control group(P<0.05).The incidence of complications in the study group was lower than that in the control group(P<0.05).Three months after operation,the prognosis of the study group was significantly better than that of the control group(P<0.05).Conclusion:The use of controlled decompression technique in unilateral craniotomy can effectively promote the recovery of neurological function in patients with contrecoup craniocerebral injury,reduce the occurrence of intraoperative encephalocele,regulate intracranial pressure and cerebral perfusion pressure,reduce complications,help to postoperative recovery,improve the quality of life and prognosis.