摘要
目的探讨脑池造瘘术及控制性引流桥前池脑脊液对重型颅脑损伤(sTBI)治疗的临床研究。方法将山西大医院神经外科自2016年9月至2018年6月收治的60例sTBI患者,采用随机数字表法将患者分为标准去骨瓣组(20例)、脑池造瘘组(20例)及脑池造瘘+引流组(20例)。患者开颅前留置脑室型颅内压(ICP)监测探头,记录术后2、6、12 h和1、3、5 d的ICP数值;术后每日评估GCS评分;术后48 h复查头颅CT,对比手术前后Rotterdam CT评分。结果去骨瓣组、脑池造瘘组与脑池造瘘+引流组各主要时间点ICP数值比较,差异有统计学意义(P<0.05)。脑池造瘘+引流组术后各主要时间点的GCS评分均略高于其余2组。脑池造瘘+引流组术后CT评分改善程度与其余2组比较,差异有统计学意义(P<0.05)。结论脑池造瘘术后对桥前池脑脊液控制性引流能恢复脑脊液循环通路、提高减压效果,促进神经功能恢复,对改善预后有一定效果。
Objective To discuss the clinical application of cisternostomy and controlled drainage that cerebrospinal fluid in prepontine cistern in patients with severe traumatic brain injury （sTBI）. Methods A total of 60 patients with sTBI in our department who needed surgical treatment were randomly divided into the standard decompression group （20 cases）, the cisternostomy group （20 cases）, the cisternostomy with drainage group （20 cases）. The ventricular intracranial pressure （ICP） monitoring probe was indwelling before craniotomy, and recorded the main postoperative time points of ICP. GCS score was evaluated daily after the surgery. CT of the brain has been countercheck. Make a score with the Rotterdam CT scale and compare it with preoperative. Results The mean ICP values at different time points in the standard decompression group, the cisternostomy group and the cisternostomy with drainage group were compared, the differences were statistically significant （P〈0.05）. The GCS scores of cisternostomy plus drainage group were slightly higher than those of the other two groups at the main time points after operation. The improvement of postoperative CT score in the group of cisternostomy with drainage was statistically significant compared with the other two groups （P〈0.05）. Conclusion Controlled drainage of cerebrospinal fluid in the prepontine cistern can restore the circulation pathway of cerebrospinal fluid, which is helpful to recover nerve function and has effect on improving prognosis.
作者
杨辉
王永红
刘震洋
仝海波
Yang Hui;Wang Yonghong;Liu Zhenyang;Tong Haibo(Department ofNeurosurgery,Shanxi Dayi Hospital Affiliated to Shanxi Medical University,Taiyuan 030000,China)
出处
《中华神经创伤外科电子杂志》
2018年第6期324-328,共5页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
关键词
重型颅脑损伤
脑池造瘘
去骨瓣减压
引流
颅内压
Severe traumatic brain injury
Cisternostomy
Decompressed craniectomy
Drainage
Intracranial pressure
