天津医药

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开放侧裂池、基底池治疗外侧裂区对冲性脑挫伤的疗效观察

陈永汉,贾林伟,张刚   

  1. 沧州市中心医院
  • 收稿日期:2013-08-12 修回日期:2014-02-09 出版日期:2014-07-15 发布日期:2014-07-15
  • 通讯作者: 贾林伟

Observations on the Effects of Opening Side Crack Pool and Basal Cistern for the Treatment of Lateral Fissure Hedge Brain Contusion

  • Received:2013-08-12 Revised:2014-02-09 Published:2014-07-15 Online:2014-07-15

摘要：

【摘要】目的 探讨外侧裂区脑挫伤术中开放侧裂池、基底池治疗脑挫裂伤术后脑血管痉挛的效果。方法将106例外侧裂区域对冲性脑挫伤患者分为对照组与治疗组，对照组给予常规开颅清除脑挫裂伤灶及血肿，治疗组在此基础上充分开放侧裂池、颈动脉池、终板池、基底池。检测术后第3、7、14天血浆和脑脊液中内皮素-1(ET-1）水平，并观察出院时格拉斯哥昏迷（GCS）评分、重症监护室（ICU）监护时间和总住院时间；术后随访3个月，统计预后良好率。结果术后患者血浆和脑脊液中ET-1水平在不同时点（血浆F时间=603.436，脑脊液F时间=684.276）、不同组间（血浆F组间=272.531，脑脊液F组间=317.641）差异均有统计学意义，从各时点看，除术后3d2组差异无统计学意义外，术后7d、14d治疗组均明显低于对照组（均P＜0.01）。治疗组出院GCS评分高于对照组，ICU监护时间和总住院时间均低于对照组（均P＜0.01）。治疗组预后良好率明显高于对照组[78.85%（41/52）vs51.85%（28/54），χ 2 =8.496，P＜ 0.01]。结论颅脑外伤术中开放侧裂池、基底池可改善脑挫伤患者的脑血管痉挛，改善预后。

关键词: 开放侧裂池, 侧裂区对冲伤, 外伤性脑血管痉挛, 内皮素-1

Abstract:

[Abstract] Objective To investigate the therapeutic effect of the lateral fissure opened intraoperative cerebral con? tusion sylvian cistern , basal cistern for improving the cerebral vasospasm. Methods A total of106patients withcerebral contusion in lateral fissure area were randomly divided into2groups. The control group was given conventional craniotomy to clear focal cerebral contusion of hematoma. And the experimental group was further to fully open sylvian cistern, jugular vein pool, endplate pool and basal cistern on the basis of the conventional craniotomy to remove the brain contusion and hemato? ma. The levels of endothelin1(ET-1) in plasma and cerebrospinal fluid (CSF) were detected postoperative 3, 7and14days. The Glasgow coma scale (GCS) score, ICU guardianship time and total length of hospital stay were observed on discharge and followed up for 3months in two groups. The rate of good prognosis was compared between two groups.Results There were significant differences in ET-1levels of plasma and CSF at different time points (plasma Ftime =603.436and CSFFtime = 684.276) between two groups of patients (plasma Ftime =272.531and CSFF=317.641). The ET-1levels were significantly lower after 7d and14d treatment in experimental group, but no significant difference3d after operation between two groups (P<0.01). The GCS score was significantly higher on discharge in experimental group than that of control group. The values of ICU guardianship time and the total hospitalization time were both significantly lower in experimental group than those of control group (P<0.01). The rate of good prognosis was significantly higher in experimental group than that of control one [78.85% (41/52) vs 51.85% (28/54), χ 2 =8.496, P<0.01]. Conclusion Openning side crack pool and basal cistern in the surgical treatment of traumatic brain injury can improve the cerebral vasospasm and prognosis.

Key words: open side crack pool, lateral fissure area hedge, traumatic cerebral vasospasm, endothelin 1