標準大骨瓣減壓術聯合血管重建術治療重型顱腦損傷的療效及對腦灌注的影響

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標準大骨瓣減壓術聯合血管重建術治療重型顱腦損傷的療效及對腦灌注的影響(論文5400字)
【摘要】目的 探討標準大骨瓣減壓術聯合血管重建術治療重型顱腦損傷的療效及對腦灌注的影響 方法 選擇2014年1月至2017年1月我院接診的90例重型顱腦損傷患者進行研究,通過隨機數表法分為觀察組(n=45)和對照組(n=45),對照組使用標準大骨瓣減壓術治療,觀察組聯合腦-硬腦膜-肌肉血管重建術治療。比較兩組血液流變學、凝血功能、顱內壓(ICP)、腦灌注量(CCP)、術后并發癥及預后。結果 手術后7d,兩組全血高切粘度、全血低切粘度、血漿粘度、紅細胞壓積較手術前均顯著降低(P<0.05),觀察組兩組全血高切粘度、全血低切粘度、血漿粘度、紅細胞壓積均明顯比對照組低(P<0.05);手術后7d,兩組凝血酶原時間(PT)、部分凝血活酶時間(APTT)、凝血酶原時間(TT)較手術前均顯著升高(P<0.05),觀察組PT、APPT、TT明顯高于對照組(P<0.05);手術后7d,兩組ICP較手術前均顯著降低,CCP顯著升高(P<0.05),觀察組ICP明顯低于對照組,CCP明顯比對照組高[(16.31±1.70)mmHg vs(21.40±1.94)mmHg,(64.98±7.30)mmHg vs(57.54±6.19)mmHg](P<0.05);兩組顱內感染、癲癇、腦積水、切口疝發生率比較均無顯著差異(P>0.05);術后6個月時,觀察組預后良好率為66.67%(30/45),明顯高于對照組的40.00%(18/45)(P<0.05)。結論 在重型顱腦損傷患者中使用標準大骨瓣減壓術聯合血管重建術效果顯著,可有效改善血液流變學和凝血功能,促進腦灌注,且術后并發癥少、預后高,值得應用推廣。
【關鍵詞】重型顱腦損傷;標準大骨瓣減壓術;血管重建術;腦灌注

Curative efficacy of standard large bone flap decompression combined with revascularization in treatment of severe craniocerebral injury and its effects on cerebral perfusion
[Abstract] Objective To study the curative efficacy of standard large bone flap decompression combined with revascularization in treatment of severe craniocerebral injury and its effects on cerebral perfusion. Methods 90 patients of severe craniocerebral injury who received therapy fromJanuary 2014 to January 2017 in our hospital were selected as research objects. According to random number table,those patients were divided into the observation group (n=45) and the control group (n=45), the control group was treated with standard large bone flap decompression, while the observation group was combined with brain-duramater-muscle revascularization. The blood rheology, coagulation function, intracranial pressure (ICP), cerebral perfusion volume (CCP), postoperative complications and prognosis were compared between the two groups. Results After surgery 7d, the whole blood viscosity, whole blood viscosity, plasma viscosity and hematocrit of two groups were significantly lower than those before surgery(P<0.05), the whole blood viscosity, whole blood viscosity, plasma viscosity and hematocrit in the observation group were significantly lower than those in the control group(P<0.05); after surgery 7d, the prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin time (TT) of two groups were significantly higher than those before operation(P<0.05), the PT, APPT and TT in the observation group were significantly higher than those in the control group(P<0.05); after surgery 7d, the ICP of two groups was significantly lower than those before operation, and the CCP was significantly increased(P<0.05), the ICP in the observation group was significantly lower than those in the control group, and the CCP was significantly higher than those in the control group[(16.31±1.70) mmHg vs(21.40±1.94)mmHg, (64.98±7.30)mmHg vs(57.54±6.19)mmHg] (P<0.05); there was no significant difference in the incidence of intracranial infection, epilepsy, hydrocephalus and incisional hernia between the two groups(P>0.05); after surgery 6 months, the good prognosis rate in the observation group was 66.67% (30/45), which was significantly higher than those in the control group 40.00%(18/45)(P<0.05). Conclusion Standard large bone flap decompression combined with revascularization is well for severe craniocerebral injury, which can effectively improve blood rheology and coagulation function, promote cerebral perfusion, and has less postoperative complications and higher prognosis, it’s worthy of popularization and application.
[Key words] Severe craniocerebral injury; Standard large bone flap decompression; Revascularization; Cerebral perfusion

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