大骨瓣减压手术对老年重型颅脑损伤患者的疗效及脑代谢能力的影响

目的探讨大骨瓣减压手术在老年重型颅脑损伤患者中的疗效及其对患者脑代谢功能的影响。方法将80例老年重型颅脑损伤患者分为观察组与对照组,每组40例。患者入院后,均给予微创穿刺钻颅,导管连接换能器,连续监测颅内压;行左侧桡动脉穿刺后置管,监测心率、血压;于颈静脉置管,以备采血之用。此后观察组给予大骨瓣减压术治疗,对照组给予内科常规治疗,对比两组患者颅内压(ICP)与脑灌注压(CCP)、脑组织氧摄取率及颈内静脉-桡动脉乳酸差(VADL)。结果两组患者治疗后ICP、CCP均显著改善(P<0.05或P<0.01),治疗后观察组显著优于对照组(P<0.05);两组患者脑组织氧摄取率治疗前后比较无统计学差异(P>0.05),治疗后两组间比较也无统计学差异(P>0.05);两组治疗后VADL均明显减低(P<0.05),治疗后6 d观察组VADL显著高于对照组(P<0.01)。结论大骨瓣减压术可有效降低老年重型颅脑损伤患者颅内压,改善脑血流灌注,缓解临床症状,降低死亡率,但对于脑组织摄取氧的能力及代谢功能并无明显效果。

Curative effect of large decompressive craniectomy on elderly patients with severe brain injury and its influence to cerebral metabolism

Objective To study the curative effect of large decompressive craniectomy on elderly patients with severe brain injury and its influence to cerebral metabolism. Methods Eighty elderly patients with severe brain injury were divided into the observation group(n=40) and the control group(n=40) randomly.All patients underwent minimally invasive skull puncture,connected to a transducer by catheter,the intracranial pressure was continuous monitored.Catheterization was performed after left radial artery puncture,the heart rate and blood pressure were monitored.Catheter placement was performed in jugular vein for blood collection.The observation group was given large decompressive craniectomy and the control group was given routine medical treatment,then the ICP,CCP,cerebral oxygen uptake rate,and VADL were contrasted between the two groups. Results ICP,CCP in the two groups were significantly improved after the treatment(P<0.05 or P<0.01),after treatment,the observation group was significantly better than the control group(P<0.05);there was no statistical difference of cerebral oxygen uptake rate in the two groups before and after treatment(P>0.05),and no statistical difference between the two groups(P>0.05);VADL were significantly lower than before treatment in the two groups(P<0.05),and in the observation group was significantly higher than in the control group 6d after the treatment(P<0.01). Conclusion Large decompressive craniectomy can effectively reduce the ICP and improve cerebral perfusion,relieve symptoms and reduce mortality,but it has no apparent effect in the ability of cerebral oxygen uptake or cerebral metabolic function.