摘要
目的探讨重症超声在老年重型颅脑损伤去骨瓣减压术后病人中的应用价值,并评价病人术后血管反应性、血流状态。方法选取我院2016年6月至2017年12月收治的老年重症颅脑损伤病人106例,所有病人行去骨瓣减压术后分别进行头部CT以及重症超声检查,比较2种检查方式的检查结果,并采用重症超声监测病人术后1~7 d脑血管反应性及脑血流情况。结果重症超声检测脑室出血、脑实质出血、中线结构移位、脑室移位及硬膜下积液等检出率与CT比较,差异无统计学意义(P>0.05),重症超声综合检出率为93.4%(99/106)。去骨瓣术后,病人大脑中动脉最大血流速度和平均血流速先降低后升高,术后3 d最大血流速度和平均血流速度最低(P<0.05);术后1~7 d,病人脑充血发生率呈逐渐递减趋势,而脑血管痉挛发生率逐渐增加;脑血管反应性术后先降低后升高,术后3 d血管反应性最低(P<0.05)。结论重症超声能够有效评估老年重症颅脑损伤病人去骨瓣术后颅内病变情况,以及病人术后脑血管反应性、脑血流情况,有助于及时反映病人病情。
Objective To explore the application of severe ultrasound in the elderly patients with severe craniocerebral injury after decompression craniotomy and to evaluate the vascular reactivity and blood flow status after operation.Methods A total of 106 elderly patients with severe craniocerebral injury treated in our hospital from June 2016 to December 2017 were selected.All patients underwent decompression of bone flaps.CT examination and severe ultrasound examination were conducted after surgery.The results of the two examination methods were compared.Severe ultrasound was used to monitor cerebrovascular reactivity and cerebral blood flow 1-7 days after surgery.Results There were no significant differences in the detection rates of intraventricular hemorrhage,intracerebral hemorrhage,midline structural shift,ventricular shift,subdural effusion between ultrasound and CT(P>0.05).The comprehensive detection rate of severe ultrasound was 93.4%(99/106).The maximum blood flow velocity and mean blood flow velocity of the middle cerebral artery decreased firstly and then increased after the treatment of bone flap.The maximum blood flow velocity and average blood flow velocity were the lowest 3 d after operation(P<0.05).From the first to seventh day after operation,the incidence rate of cerebral hyperemia decreased gradually,while the incidence rate of cerebral vasospasm increased gradually.Cerebral vascular reactivity decreased first and then increased,and vascular reactivity was the lowest 3 d after surgery(P<0.05).Conclusions Severe ultrasound can effectively evaluate intracranial lesions in the patients with severe craniocerebral injury after craniotomy,and it can be used to evaluate the postoperative cerebrovascular reactivity and cerebral blood flow in the patients with severe traumatic brain injury.It is helpful to timely reflect the patient s condition.
作者
徐万忠
白艳丽
王晓麒
XU Wan-zhong;BAI Yan-Li;WANG Xiao-qi(ICU,People’s Hospital of Guyuan City,Guyuan 756000,China)
出处
《实用老年医学》
CAS
2019年第8期788-792,共5页
Practical Geriatrics
基金
宁夏固原市科技项目(GK2017-018)
关键词
重症超声
重症颅脑损伤
老年人
血管反应性
脑血流监测
severe ultrasound
severe craniocerebral injury
aged
vascular reactivity
cerebral blood flow monitoring
