慢性意识障碍患者同期行颅骨修补和脑室-腹腔分流术后的意识恢复及并发症分析

目的研究慢性意识障碍患者颅骨修补与脑室-腹腔分流手术后,意识障碍恢复效果及并发症。方法郑州大学第五附属医院神经外科2015年1月—2018年8月同时行颅骨修补和脑室-腹腔分流术的18例慢性意识障碍患者。测评患者手术前后的修订版昏迷恢复量表(coma recovery scale-revised,CRS-R)评分和颅内压力变化;分析手术效果和并发症。结果8例患者(44.4%)在术后1年内完全恢复意识。与术前相比,术后1个月、3个月、6个月、1年时的CRS-R评分有不同程度的提高(P<0.05),术后1个月、3个月、6个月的子量表评分也有不同程度的提高(P<0.05)。颅骨修补后1周内,颅内压力比术前提高了(33.94±9.65)mm H 2O,2周后无明显变化。术后严重并发症发生率为33%。结论病情稳定的慢性意识障碍患者同时行颅骨修补和脑室-腹腔分流手术是一种有效的方法;尤其有利于微意识状态患者意识的恢复和神经功能康复。

Evaluation of curative effect and complication in one-stage operation of ventriculoperitoneal shunt and cranioplasty for patient with chronic disorders of consciousness

Objective To study the effects and complication of ventriculoperitoneal shunt and cranioplasty on one-stage in patients with chronic disorders of consciousness(DOC).Methods 18 patients with DOC who underwent cranioplasty and ventriculoperitoneal shunt in the department of neurosurgery at the Fifth Affiliated Hospital of Zhengzhou University from January 2015 to August 2018 were collected.The CRS-R scores and the intracranial pressure were evaluated before and after operation.The recovery of consciousness and intracranial pressure were measured before and after the operation,the changes were analyzed,and the complications of patients also were analyzed.Results 8 patients with DOC restored consciousness within one year after surgery.The CRS-Rscores increased with the time going on,compared with the baselines,and the CRS-R scores at the 1month,6 months and a year were significantly higher than the baseline.Visual,auditory and motor subscales were also significantly higher than the baseline in this period(P<0.05).Intracranial pressure was increased(33.94±9.65)mm H 2O early after cranioplasty.All the early and long-term severe complications were 33%.Conclusion Cranioplasty and ventriculoperitoneal shunt is suggested to be a efficacious way to treat decompressive craniectomy defect and communicating hydrocephalus,especially beneficial to the recovery of consciousness level and functional in patients with MCS.