摘要
目的比较标准大骨瓣减压联合脑-硬脑膜-肌肉血管重建术与传统标准大骨瓣减压术治疗重型颅脑损伤的临床效果。方法选择2012年3月-2015年3月收治的以额颞叶脑挫裂伤为主的重型颅脑损伤患者48例,随机分为试验组和对照组,每组24例。试验组采用标准大骨瓣减压联合脑-硬脑膜-肌肉血管重建术,对照组采用传统标准大骨瓣减压术,术后通过CT灌注成像(CTP)观察脑组织血流动力学改变,指标包括脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP),以及术侧与对侧的比值(即r CBF、r CBV、r MTT、r TTP),并对术后半年的格拉斯哥预后评分(GOS)情况进行分析。结果试验组术后1周及1个月时的CBF、CBV高于对照组,MTT、TTP低于对照组,差异均有统计学意义(P<0.05);试验组术后1周和1个月时的r CBF、r CBV、r MTT、r TTP差异无统计学意义(P>0.05),而对照组术后1周时的r CBF、r CBV值高于术后1个月时,r MTT、r TTP低于术后1个月时,差异有统计学意义(P<0.05)。术后半年GOS评分结果显示,试验组中恢复较好(包括良好和中残)的比例高于对照组,而恢复较差(包括重残、植物状态、死亡)的比例低于对照组,差异均有统计学意义(P<0.05)。结论标准大骨瓣减压联合脑-硬脑膜-肌肉血管重建术在降低重症颅脑损伤患者颅内压的同时能有效改善受损脑组织的血供,疗效显著,预后较好,值得临床应用及推广。
Objective To compare the efficacies of large decompressive craniectomy combined with vascular reconstruction and traditional decompressive craniectomy in treatment of severe brain injury. Methods Forty-eight patients with severe brain injury, which was dominated by brain contusion to the frontoparietal lobes, admitted to our hospital from March 2012 to March 2014 were divided equally into experimental group and control group. The patients in the experimental group underwent large decompressive craniectomy combined with vascular reconstruction, and the patients in the control group received traditional decompressive craniectomy. The hemodynamic changes including cerebral blood flow（CBF）, cerebral blood volume（CBV）, mean transit time（MTT）, time to peak（TTP） and the ratios of these values（rC BF, rC BV, rM TT and rT TP） on two sides were observed by CT perfusion imaging, and the Glasgow outcome score（GOS） was analyzed 6 months after operation. Results The CBF and CBV scores in experimental group were higher than those in the control group at 1 week and 1 month after the operation（P0.05）. The MTT and TTP scores in the experimental group were lower than those in the control group at 1 week and 1 month after the operation（P0.05）. The rC BF and rC BV values were higher in 1 week than in 1 month, while the rM TT and rT TP values were lower in 1 week than in 1 month in the control group（P0.05）, while there was no statistical difference in rC BF, rC BV, rM TT and rT TP between 1 week and 1 month in the experimental group（P0.05）. The rate of satisfactory recovery（including good recovery and moderate disability） was higher in the experimental group than in the control group, while the rate of poor recovery（includingsevere disability, vegetative state and death） was lower in the experimental group than in the control group（P0.05）. Conclusion The large decompressive craniectomy combined with vascular reconstruction can not only decrease the intracranial pressure, but also recover the blood supply of brain, thus deserving the clinical application and popularization.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2015年第11期934-937,共4页
Medical Journal of Chinese People's Liberation Army
基金
海南省自然科学基金(20158349)
海南省医药卫生科研项目(1424320.27A2008)~~
关键词
颅脑损伤
减压颅骨切除术
脑血管重建术
灌注成像
craniocerebral trauma
decompressive craniectomy
cerebral revascularization
perfusion imaging
