CAJ | 학술논문

目的：分析颅骨缺损合并慢性脑积水致脑膨出的患者在行同期颅骨修补及脑室‐腹腔分流术时，手术前、后的脑室压力及脑血流速度的变化情况，从而为制定合理的临床治疗策略提供依据，指导临床个体化治疗。方法选取2007年1月至2013年1月沧州市中心医院收治的因外伤原因行去骨瓣减压术后并发慢性脑积水导致局部脑膨出的患者106例，术前及术后行腰穿测定脑脊液压力，测量术前骨窗膨出高度；检测脑血流相关参数，分析患者颅骨修补前、后颅内压的变化情况和左、右侧的颈内动脉终末段、大脑前动脉、大脑中动脉以及基底动脉血流速度的变化。结果术前骨窗膨出超过3 cm的患者同期行颅骨修补及脑室‐腹腔分流术，术后脑脊液压力明显升高，而膨出低于3 cm的患者术前术后脑脊液压力变化不大；手术前后脑血流速度比较，差异无统计学意义（ P＞0．05）。结论术前颅骨膨出程度与术后颅内压升高相关，以术前骨窗膨出3 cm为临界值，对临床分流管的选择具有指导意义；还应结合脑血流速度以外的其他指标对脑血供的改善进行评价。
목적：분석로골결손합병만성뇌적수치뇌팽출적환자재행동기로골수보급뇌실‐복강분류술시，수술전、후적뇌실압력급뇌혈류속도적변화정황，종이위제정합리적림상치료책략제공의거，지도림상개체화치료。방법선취2007년1월지2013년1월창주시중심의원수치적인외상원인행거골판감압술후병발만성뇌적수도치국부뇌팽출적환자106례，술전급술후행요천측정뇌척액압력，측량술전골창팽출고도；검측뇌혈류상관삼수，분석환자로골수보전、후로내압적변화정황화좌、우측적경내동맥종말단、대뇌전동맥、대뇌중동맥이급기저동맥혈류속도적변화。결과술전골창팽출초과3 cm적환자동기행로골수보급뇌실‐복강분류술，술후뇌척액압력명현승고，이팽출저우3 cm적환자술전술후뇌척액압력변화불대；수술전후뇌혈류속도비교，차이무통계학의의（ P＞0．05）。결론술전로골팽출정도여술후로내압승고상관，이술전골창팽출3 cm위림계치，대림상분류관적선택구유지도의의；환응결합뇌혈류속도이외적기타지표대뇌혈공적개선진행평개。
Objective To analyze changes in intracranial pressure and cerebral blood flow before and after one‐stage ventriculo‐peritoneal shunt and cranioplasty in patients with encephalocele induced by cranial defect combined with primary hydrocephalus ,in order to provide a basis for rational therapy and guide the individualized therapy. Methods A total of 106 patients with encephalocele induced by primary hydrocephalus after decompressive craniec‐tomy ,treated in this hospital from Jan. 2007 to Jan. 2013 ,were enrolled in this study. Cerebrospinal fluid pressure was detected by lumbar puncture before and after one‐stage operation ,and the height of bone window bulging was meas‐ured as well. Parameters related to cerebral blood flow were detected. Changes in intracranial pressure and blood flow velocity of the end of internal carotid artery(ICA) on the left and right side ,anterior cerebral artery(ACA) ,middle cerebral artery(MCA )and basilar artery before and after one‐stage operation were analyzed. Results In patients whose height of bone window bulging was more than 3 cm ,after one‐stage operation the intracranial pressure was ob‐viously increased;in patients whose height of bone window building was less than 3 cm ,after one‐stage operation the intracranial pressure changed slightly. There was no significant difference of blood flow velocity between that of be‐fore and after one‐stage operation(P>0. 05). Conclusion The degree of preoperative bone window bulging could be related to the increase of postoperative intracranial pressure ,and setting 3 cm as a critical value could be benefit for the selection of bypass tube. Except for blood flow velocity ,it might be necessary to combing other indicators to eval‐uate the improvement of cerebral blood supply.