钟向球;刘谦;植汉兴;李雄辉;潘秀武;何木良;

• 1:贺州市中医医院

摘要(Abstract)：

目的分析重型颅脑损伤患者术中发生脑膨出的原因。方法回顾性分析60例接受重型颅脑创伤手术患者的临床资料,记录术中脑膨出的发生情况。将术中发生膨出的33例患者纳入观察组,未发生术中脑膨出的27例患者纳入对照组,对比分析2组患者术前血气分析结果,了解血气酸碱度与术中脑膨出的关系。结果观察组31例患者术前血气酸碱度下降,对照组仅5例术前血气分析下降,术前血气酸碱度下降患者易发生术中脑膨出。结论术前缺氧导致体内血气酸碱度下降,容易发生术中脑膨出,如术前能提前干预,可以降低术中脑膨出的发生率,改善患者预后。

关键词(KeyWords)： 颅脑创伤;术前血气酸碱度;术中脑膨出;脑肿胀;颅内血肿

Abstract:

Keywords:

基金项目(Foundation): 贺州市科学研究与技术开发计划项目(编号:贺科攻1812008)

作者(Authors): 钟向球;刘谦;植汉兴;李雄辉;潘秀武;何木良;

参考文献(References)：

• [1] GUMUSSOY M,UGUR O,CUKUROVA I,et al.Recurrent meningitis and frontal encephalocele as delayed complications of craniofacial trauma[J].J Craniofac Surg,2014,25(2):529-530.
• [2] LIU J,LI Q,ZHANG K S,et al.Downregulation of the Long Non Coding R NA Meg3 PRomotes Angiogenesis After Ishemic Brain Injury by Activating Notch Singnaling[J].Mol Neurobiol,2017,54(10):8179-8190.
• [3] CRUZ S A,QIN Z,STEWAR A F R,et al.Dabrafenib,an inhibitor of RIP3 Kinase-dependent necroptosis,reduces ischemic brain injury[J].Neural Regen Res,2018,13(2):252-256.
• [4] BRUAH U,DAYAL M,GIRIDHAR K K,et al.Successfui management of case of Tessier’s cleft number 0 and 14 with associated encephlocoele[J].Indian J Anaesth,2016,60(8):597-599.
• [5] NACHERGAELE P,VAN CALENBERGH F,LAGAE L.Craniocerebral birth injuries in term newborn infants:Aretrospective series[J].Childs Nerv Syst,2017,33(11):1927-1935.
• [6] DAWENDRAN A.Giant occipital encephalocele with chiari malformation Type3[J].J Neurosci Pural Pract,2018,9(4):619-621.
• [7] 谢永锋.重型颅脑外伤术中急性脑膨出的临床分析[J].中国实用神经疾病杂志,2016,19(14):10.
• [8] 程品文,张玉定.重型颅脑损伤术中急性脑膨出情况及其影响因素分析[J].中国实用神经疾病杂志,2016,19(14):104-105.
• [9] BAO Y H,LIANG Y M,GAO G Y,et al.BILATERAL decompressive craniectomy for patients with malignant diffuse brain swelling after severe traumatic brain injury:a 37case study[J].J Neurotrauma,2010,27(2):341-347.
• [10] LABATO R D,SARABTA R,CORDOBES F,et al.Posttraumatic cerebral Hemispheric swelling.Analysis of 55 cases studied with conputerized tomography[J].J Neurosurg,1988,68(3):417-423.
• [11] GOKINA N I,PARK K M,MCELROY-YAGGY K,et al.Effects of Rho kinase inhibition on cerebral artery myogenic tone and reactivity[J].J Appl Physiol,2005,98(5):1940-1948.
• [12] DAVIDSON J R,MACK J,GUTNIKOVA A,et al.Developmental changes in human dural innervation[J].Childs Nerv Syst,2012,28(5):665-671.
• [13] CHEN W,SHENG J,PENG G,et al.Early stage alterations of catecholamine and adrenocorticotropic hormone levels in posttraumatic acute diffuse brain swelling[J].Brain Res Bull,2017,130:47-52.
• [14] PAG Q,LU X,GREGERSEN H,et al.Biomcchanical properties of porcine cerebral bridging veins with referance to the zero-stress state[J].J Vasc Res,2001,38(1):83-90.
• [15] REHMAN L,FAROOQ G,BUKHARI L.Neurosurgical interventions for occipital encephalocele[J].Asian Neurosurg,201813(2):233-237.DOI:10.4103/1793-5482.228549.
• [16] 王争.80例颅脑外伤术中急性脑膨出原因分析及处理方式探讨[J].中国实用神经疾病杂志,2015,18(9):53-54.
• [17] SHARIFI G,ALAVI E,JALESSI M,et al.Transethmoidal encephalocele after reduction of high intracranial pressure in aqueductal stenosis[J].Turk Neurosurg,2014,24(1):75-77.
• [18] WANG X,ZHANG R,TANG Z,et al.Factors influencing the desision to retain r remove the bone flap of aduli patients with traumatis brain injury:a retrospective study[J].Turk Neurosurg,2014,24(3):351-356.
• [19] JUNGNER M,LUNDBLAD C,BENTZER P.Rosuwastatin in experimental brain trauma:improved capillary patency but no effect on edema or cerebral blood flow[J].Microvasc Res,2013,88(4):48-55.
• [20] ROSENBLATT A L,SCRIWANI P V,CASERTO B G,et al.imaging diagnosis meningoencephalitis secondary to suppurative rhinitis and meningoencephalocele infection in a dog[J].Vet Radiol Ultrasound,2014,55(6):614-619.
• [21] SOMMA L,LACOANGELI M,NASI D,et al.Combined supra transorbita keyhole approach for teeatment of delayed intraorbital encephalocele:a minimally invasive approach for an unusual complication of decompressive craniectomy[J].Surg Neurolint,2016,7(7):12-16.
• [22] RIBEIRO C J N,ARAUJO A C S,BRITO S B,et al.Pain assessment of trau matic brain injury victims using the Brazilian version of the Behavioral Pain Scale[J].Rev Bra Rerintensiva,2018,30(1):42-49.
• [23] CHO Y J,KANG S H.Review of Cranioplasty after Decompressive Graniectomy[J].Korean J Neurotrauma,2017,13(1):914.
• [24] 周晓慧,张艺萍,孙培.颅脑创伤合并脑心综合征患者预后与QRS波向量的相关性研究[J].中国实用神经疾病杂志,2020,23(13):1144-1149.DOI:10.12083/SYSJ.2020.13.260.
• [25] CHAMPAGNE A A,COVERDALE N S,ROSS A,et al.Multi-modal normalization of resting-state using local physiology reduceschanges in functional connectivity patterns observed in mTBI patients[J].Neuroimage Clin,2020,26:102204.DOI:10.1016/j.nicl.2020.102204.
• [26] BUNYA N,AISAKA W,MIYATA K,et al.PrognosticSignificance of the Difference Between Mixed and Jugular Venous OxygenSaturation After Severe Traumatic Brain Injury:A Post Hoc Analysis of the BrainHypothermia Study[J].World Neurosurg,2020,137:e68-e74.DOI:10.1016/j.wneu.2020.01.004.
• [27] LU H,GONG Z,SONG Y,et al.Application of P(jv-a) CO2 inmonitoring cerebral oxygen supply-demand balance in injured brain[J].J ClinNeurosci,2020,71:213-216.DOI:10.1016/j.jocn.2019.11.028.
• [28] YANG J T,ERICKSON S L,KILLIEN E Y,et al.AgreementBetween Arterial Carbon Dioxide Levels With End-Tidal Carbon Dioxide Levels andAssociated Factors in Children Hospitalized With Traumatic Brain Injury[J].JAMANetw Open,2019,2(8):e199448.DOI:10.1001/jamanetworkopen.2019.9448.
• [29] RASS V,SOLARI D,IANOSI B,et al.Protocolized BrainOxygen Optimization in Subarachnoid Hemorrhage[J].Neurocrit Care,2019,31(2):263-272.DOI:10.1007/s12028-019-00753-0.
• [30] NAYLOR J F,BORGMAN M A,APRIL M D,et al.Normobaric hyperoxia inwartime pediatric trauma casualties[J].Am J Emerg Med,2020,38(4):709-714.DOI:10.1016/j.ajem.2019.06.005.
• [31] TOMAR G S,SINGH G P,BITHAL P,et al.Comparison ofEffects of Manual and Mechanical Airway Clearance Techniques on IntracranialPressure in Patients With Severe Traumatic Brain Injury on a Ventilator:Randomized,Crossover Trial[J].Phys Ther,2019,99(4):388-395.DOI:10.1093/ptj/pzy141.
• [32] BRAGIN D E,STATOM G L,NEMOTO E M.Induced Dynamic Intracranial Pressure andCerebrovascular Reactivity Assessment of Cerebrovascular Autoregulation AfterTraumatic Brain Injury with High Intracranial Pressure in Rats[J].Acta NeurochirSuppl,2018,126:309-312.DOI:10.1007/978-3-319-65798-1_60.
• [33] WANG L,ZHAO C,WU S,et al.Hydrogen Gas TreatmentImproves the Neurological Outcome After Traumatic Brain Injury Via IncreasingmiR-21 Expression[J].Shock,2018,50(3):308-315.DOI:10.1097/SHK.0000000000001018.