去骨瓣减压对外伤性脑血管痉挛状态影响的研究

目的 通过对去骨瓣减压术后患者情况综合研究外伤性脑血管痉挛（CVS）的危险因素. 方法 对本院2010年3月至2011年3月收治的30例幕上急性硬膜外血肿合并外伤性蛛网膜下腔出血的脑疝患者,首先予经颅多普勒超声（TCD）检测,并予脑室穿刺行颅内压动态监测,再行去骨瓣减压术,术后连续7天行TCD及颅内压监测并作相关数据分析. 结果 18例发生CVS（占60％）,脑中线结构钟摆程度≥2cm的CVS发生率显著高于脑中线结构钟摆程度＜2cm;t-SAH积血Hijdra法计算6分以下20例中有9例（45％）、6以上10例中有9例（90％）发生CVS;脑疝至手术处理时间2小时以上3例中有3例（100％）、2小时以下27例中有15例（55.6％）发生CVS；手术进行硬膜下探查19例中有8例（50％）、未探查11例中有10例（90.9％）发生CVS;年龄＞50岁18例中有6例（33.3％）、＜50岁12例（40％）中有12例（100％）发生CVS. 结论 经血肿清除及去骨瓣减压术后的患者所发生的脑血管痉挛情况与患者术前术后脑中线结构钟摆程度、蛛网膜下腔出血量、脑疝至手术处理时间的长短、是否进行硬膜下探查、年龄等情况有关.

Study on traumatic cerebral vasospasm after decompressive craniectomy

Objective To study the risk factors of traumatic cerebral vasospasm （CVS） after decompressive craniectomy. Methods 30 cas- es of acute supratentorial epidural hematoma and traumatic subarachnoid hemorrhage with cerebral hernia admitted in our hospital from March 2010 to March 2011 were included. All cases were detected with transcranial Doppler （TCD） first. They were given ventricle puncture to monitor intracranial pressure, then undergone deeompressive craniectomy. After operation, TCD was detected and intracranial pressure was monitored for 7 days in all patients. Results CVS was found in 18 （60%） cases. Incidence of CVS in the patients with more than 2 cm brain midline structure displacement was significantly higher than in the patients with less than 2 cm displacement. The level of t-SAH was evaluated by Hijdra＇s method, and there were 20 patients （66.6%） under 6 points,in which 9 cases （45%） were found to have CVS. 10 patients （33.3%） were above 6 points,in which 9 patients （90%） were found to have CVS. In 3 cases （10%）,the time from brain herniation to operation processing was longer than 2 hours, CVS was found in all 3 cases （100%）. In 27 cases （90%）, the time was less than 2 hours, and CVS was found in 15 patients （55.6%）. Subdural exploration was performed in 19 cases （63.3%）,in which 8 cases （50%） were found to have CVS. And in other 11 cases （36.6%） who hasn＇t been given a subdural exploration, CVS was found in 10 patients （90.9%）. There was 18 cases （60%） older than 50, in which CVS was found in 6 patients （33.3%）. Other 12 cases （40%） were younger than 50,in which CVS was found in 12 patients （100%）. Conclusion The degree of the cerebral vasospasm after decompressive craniectomy was related to the brain midline structure displacement, the amount of subaraehnoid hemorrhage, the time from brain herniation to operation,underwent subdural exploration or not, age, etc.