大骨瓣减压术改善重型颅脑外伤患者脑血流及脑代谢的临床研究(1)
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[摘要] 目的：探讨大骨瓣减压术对重型颅脑外伤患者脑血流量及脑代谢的影响。方法：选择本院2007年5月~2010年6月收治的重型颅脑外伤患者60例，其中38例给予大骨瓣减压治疗(观察组)，22例患者行药物治疗(对照组)，全部患者入院时均微创穿刺钻颅，监测颅内压(ICP)，左侧桡静脉穿刺监测平均动脉压(MAP)、心率(HR)，并进行桡动脉、颈内静脉血气分析，包括血糖、血乳酸、血氧饱和度、血氧分压、血红蛋白，治疗前、治疗后1、3、6 d根据测定指标计算患者脑灌注压(CCP=MAP-ICP)、颈内静脉-桡动脉乳酸差、脑氧摄取率，比较两组各指标。结果：术后第1、3、6天观察组≤50岁患者脑氧摄取率明显高于对照组(P<0.05)，>50岁的患者脑氧摄取率低于对照组(P<0.05)；术后第3、6天观察组≤50岁患者颈内静脉—动脉乳酸差明显低于对照组(P<0.05)，>50岁的患者颈内静脉—动脉乳酸差高于对照组(P<0.05)；观察组术后颅内压均低于对照组(P<0.05)，脑灌注压高于对照组(P<0.05)。结论：大骨瓣减压可有效降低重型颅脑损伤患者颅内压，提高脑灌注压，可明显提高≤50岁的患者的脑氧摄取率，但是>50岁的患者则未明显改善脑氧摄取率。
[关键词] 大骨瓣减压；重型颅脑外伤；脑代谢；脑血流
[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721(2012)01(a)-010-03
Clinical studies of large decompressive craniectomy to improve cerebral blood flow and brain metabolism in patients with severe brain injury
LV Heli
Neurosurgery Department of Heze Chinese Medicine Hospital in Shandong Province, Heze 274000, China
[Abstract] Objective: To investigate the effect of large decompressive craniectomy on cerebral blood flow and brain metabolism in patients with severe traumatic brain injury. Methods: Sixty patients with severe brain injury in our hospital from May 2007 to June 2010 were selected as reasch objects of which 38 cases were treated with hemicraniectomy treatment (observation group), 22 patients were given medicine therapy (control group), All patients were given minimally invasive cranial drill to monitor intracranial pressure (ICP), the left radial vein puncture to monitor mean arterial pressure (MAP), heart rate (HR), and made blood gas analysis of the radial artery, internal jugular venous, including blood glucose, blood lactate, oxygen saturation, blood oxygen pressure, hemoglobin. to measure cerebral perfusion pressure (CCP = MAP-ICP), jugular vein-the radial artery lactate, cerebral oxygen uptake rate before treatment and 1, 3, 6 days after treatment, compared indicators of two groups ......
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