大骨瓣减压手术对老年重型颅脑损伤患者疗效及脑代谢能力的影响

摘要

目的 探讨大骨瓣减压手术在老年重型颅脑损伤患者中的疗效及其对患者脑代谢功能的影响.方法 80例老年重型颅脑损伤患者随机分为观察组与对照组,每组各40例,观察组给予大骨瓣减压术治疗,对照组给予保守治疗,对比两组患者颅内压(ICP)、脑灌注压(CCP),脑组织氧摄取率及颈内静脉-桡动脉乳酸差(VADL).结果 两组患者治疗后ICP、CCP均显著改善(P<0.05或P<0.01),治疗后观察组显著优于对照组(P<0.05);两组脑组织氧摄取率治疗前后差异无统计学意义(P>0.05),治疗后两组问比较差异无统计学意义(P>0.05);两组治疗后VADL均明显减低(P<0.05),治疗后6 d时观察组VADL显著高于对照组(P<0.01).结论 大骨瓣减压术可有效降低老年重型颅脑损伤患者颅内压,改善脑血流关注,缓解临床症状,降低死亡率,但对于脑组织摄取氧的能力及代谢功能并无明显效果.%Objective To study the clinical effects and influence on cerebral metabolism of large trauma oraniotomy for elderly patients with severe brain injury. Methods SO elderly patients with severe brain injury were divided Into the observation group (n= 40) and the control group (n= 40) randomly, the observation group was given large trauma cranlotomy and the control group was given conservative treatment, then the ICP, CCP, cerebral oxygen uptake rate and VADL were contrasted between the two groups. Results TCP, CCP In the two groups were significantly Improved after the treatment (P ＜ 0.05 or P＜ 0.01), the observation group was better than the control group after treatment (P ＜ 0.05): there was no significantly difference In cerebral oxygen uptake rate In the two groups before and after treatment (P ＞ 0.05), and no significantly difference between the two groups after treatment (P ＞ 0.05); VADL was significantly lower than before in the two groups (P ＜ 0.05), and the observation group was significantly higher than the control group 6 days after the treatment (P ＜ 0.01). Conclusion Large trauma craniotomy can effectively reduce the ICP and improve cerebral perfuslon, relieve symptoms and reduce mortality, but It has no apparent effect in the ability of cerebral oxygen uptake or cerebral metabolic function.