颅脑彩超在去骨瓣减压术后高血压脑出血患者中的应用研究

目的 对高血压脑出血去骨瓣减压术后床边颅脑彩超的应用价值分析。 方法 回顾性分析安徽省亳州市人民医院2017年1月—2018年12月收治行去骨瓣减压术并在术后常规行生命体征实时监测、床边颅脑彩超监测与头颅CT定期复查的32例高血压脑出血患者为实验组。选择既往去骨瓣减压术后未行颅脑超声监测的32例高血压脑出血患者为对照组,对比2组患者再手术、恢复情况及预后。 结果 术后实验组颅内压>20 mm Hg (1 mm Hg=0.133 kPa)患者舒张期末流速下降,搏动指数升高,与颅内压正常者相比差异有统计学意义(均P<0.05)。实验组术后经床边颅脑彩超共发现颅内病灶9例,以CT检查结果作为金标准,颅脑彩超诊断术后并发症符合率81.82%。实验组病情变化再次手术6例,经床旁超声监测颅内血肿体积、血肿同侧侧脑室宽度与CT检查有较高一致性(t=0.155、0.147,P=0.880、0.886)。与对照组比较,实验组二次手术时间更快,术后1周GCS评分提高,出院mRs评分降低,术后90 d脑疝发生率更低(均P<0.05)。 结论 高血压脑出血去骨瓣减压术后应用床边颅脑彩超能够及时监测患者术后病情变化,指导二次手术,值得选择。 

Application of color Doppler ultrasound in patients with hypertensive intracerebral hemorrhage after decompressive craniectomy

Objective To analyze the application and value of bedside craniocerebral color Doppler ultrasonography in patients with hypertensive intracerebral hemorrhage after decompressive craniectomy. Methods A retrospective analysis of 32 cases from January 2017 to December 2018 in Bozhou People's Hospital of Anhui Province underwent decompressive bone flap decompression and routinely performed real-time monitoring of vital signs, bedside craniocerebral ultrasonography and regular skull CT review Patients with hypertensive cerebral hemorrhage were the experimental group. A total of 32 patients with hypertensive cerebral hemorrhage who had not undergone craniocerebral ultrasonography after decompressive decompression of the bone flap were selected as the control group, and the reoperation, recovery and prognosis of the two groups were compared. Results Patients with intracranial pressure> 20 mm Hg(1 mm Hg=0.133 kPa) in the experimental group after surgery had decreased end-diastolic flow velocity and increased pulsatility index, which was significantly different from those with normal intracranial pressure(all P<0.05). In the experimental group, 9 cases of intracranial lesions were found by bedside cranial color Doppler ultrasound. CT results were used as the gold standard. The coincidence rate of postoperative complications was 81.82%. In the experimental group, 6 patients underwent reoperation, and the intracranial hematoma volume and the lateral ventricle width on the ipsilateral side of the hematoma were highly consistent with CT examination(t=0.155, 0.147, P= 0.880, 0.886). Compared with the control group, the second operation time in the experimental group was faster, the GCS score increased at 1 week postoperatively, the discharge mRs score decreased, and the incidence of cerebral hernia was lower at 90 days after surgery(all P<0.05). Conclusion The use of bedside craniocerebral ultrasound after decompression of hypertensive intracerebral hemorrhage and decompression of bone flaps can monitor the postoperative condition of the patient in time and guide the second operation.