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中华神经创伤外科电子杂志 ›› 2018, Vol. 04 ›› Issue (06) : 324 -328. doi: 10.3877/cma.j.issn.2095-9141.2018.06.002

所属专题: 文献

临床研究

脑池造瘘术及控制性引流在重型颅脑损伤治疗中的临床研究
杨辉1, 王永红1, 刘震洋1, 仝海波1,()   
  1. 1. 030000 太原,山西医科大学附属大医院神经外科
  • 收稿日期:2018-11-07 出版日期:2018-12-15
  • 通信作者: 仝海波

Clinical study on the treatment of severe traumatic brain injury with cisternostomy and controlled drainage

Hui Yang1, Yonghong Wang1, Zhenyang Liu1, Haibo Tong1,()   

  1. 1. Department of Neurosurgery, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan 030000, China
  • Received:2018-11-07 Published:2018-12-15
  • Corresponding author: Haibo Tong
  • About author:
    Corresponding author: Tong Haibo, Email:
引用本文:

杨辉, 王永红, 刘震洋, 仝海波. 脑池造瘘术及控制性引流在重型颅脑损伤治疗中的临床研究[J/OL]. 中华神经创伤外科电子杂志, 2018, 04(06): 324-328.

Hui Yang, Yonghong Wang, Zhenyang Liu, Haibo Tong. Clinical study on the treatment of severe traumatic brain injury with cisternostomy and controlled drainage[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 324-328.

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.

表1 3组患者术后颅内压值比较(±s,mmHg)
表2 3组患者术前、术后GCS评分比较(±s,分)
表3 3组患者术前、术后CT评分比较[例(%)]
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