CTP在颅骨修补术前后脑灌注变化和手术时机选择的研究

发布时间：2018-03-23 13:07

本文选题：CT脑灌注成像　切入点：颅骨修补术　出处：《兰州大学》2015年硕士论文

【摘要】：目的通过CT灌注(CT perfusion,CTP)技术检测颅骨修补术前后颅骨缺损区大脑皮层脑血流灌注变化情况,研究不同手术时期、不同原发病进行颅骨缺损修补脑灌注各指标间的关系,了解超早期修补在改善脑灌注等方面的优越性,为临床更好地把握颅骨修补时机和治疗提供理论依据。方法本研究对象为38例去骨瓣减压术后1-6个月病人,男26例,女12例,年龄在20～61岁之间,平均41岁。其中交通事故伤25例,坠落伤8例,高血压脑出血5例。分别于颅骨修补术术前2天和术后第15天采用64层螺旋CT行脑灌注扫描一次,并同步行神经功能缺失评分。将患者颅骨修补手术前后脑灌注指标对照,分析颅骨修补术前后患侧和健侧大脑皮层、基底节区和丘脑CTP各指标变化规律。按照手术时机选择分为两组,超早期颅骨修补组(1月组)和对照组(3月组),通过CTP检查,收集颅骨缺损修补手术前后缺损区大脑皮层脑血流量的变化的具体数值,比较两组患者手术前后缺损区大脑皮层CBF变化情况;比较手术时机选择1月组和3月组手术的患者术前及术后神经功能缺失改善情况、术后手术并发症发生率、手术过程中情况等变化情况；比较硬脑膜外、下血肿、脑挫裂伤、脑内血肿等不同原发病导致的颅骨缺损,修补术前后脑皮层血流灌注情况。结果颅骨缺损修补术术前患侧CBF较健侧有明显差异,患侧CBF明显低于健侧,有统计学差异(P0.05)。术后患侧CBF从术前从52.57±14.40ml/100g/min增至术后70.55±15.00ml/100g/min,有统计学差异(P0.05),而丘脑、基底节CBF术前、后无明显变化,无统计学差异(P0.05)超早期颅骨修补组(减压术后1个月手术组)和对照组(减压术后3个月手术组)CBF有明显改善,有统计学差异(P0.05)。两组间并发症发生、手术历时、出血等情况比较无明显差异,无统计学差异(P0.05)。术后神经功能缺失评分较术前明显改善,有明显统计学差异(P0.05)。不同原发病分组比较CBF改善情况有统计学差异(P0.05)。结论1.颅骨修补术前患侧大脑皮层处于低灌注状态,术后低灌注状态明显好转。2.通过比较超早期修补组和对照组CBF变化情况,超早期修补组患侧大脑皮层血液灌注明显优于对照组。3.从神经功能改善情况比较两组统计学差异,超早期修补组明显优于对照组。两组并发症发生率、手术时间、出血对比,没有明显统计学意义,故颅骨缺损修补手术时机在无明显禁忌症的情况下尽早修补,能使患者最大程度恢复神经功能。4.不同原发病(硬脑膜外血肿、硬脑膜下血肿、脑挫裂伤、脑内血肿)患者颅骨缺损术前缺损区大脑皮层低灌注程度与原发脑损伤程度有明显相关性。即低灌注状态脑内血肿脑挫裂伤硬脑膜外、下血肿。术后对应区CBF增加,低灌注改善程度脑内血肿脑挫裂伤硬脑膜外、下血肿。所以,在脑组织损伤越严重的患者,在无手术禁忌的情况下,越应该提倡超早期行颅骨缺损修补术。5.超早期颅骨修补相比起早期的颅骨修补来说,手术时机更加合适,能明显改善缺损区大脑皮层的脑血流灌情况,进而促进神经元功能恢复,减少远期神经功能缺失和继发性脑损害的发生。
[Abstract]:By CT perfusion (CT perfusion, CTP) were detected before and after cranioplasty technique of skull defect area of cerebral cortex cerebral blood perfusion changes of different operation time, the incidence of different indicators for repair of skull defects between cerebral perfusion, understand the superiority of ultra early repair in improving cerebral perfusion, and provide a theoretical basis for the to better grasp the clinical cranioplasty timing and treatment method. The object of this study for 1-6 months in 38 patients after decompressive craniectomy, male 26 cases, female 12 cases, aged 20~61 years old, average 41 years old. There were 25 cases of traffic accidents, 8 cases of falling injury, 5 cases of hypertensive cerebral hemorrhage. In cranioplasty 2 days before operation and fifteenth days after surgery using 64 slice spiral CT perfusion scan, and synchronization for nerve function defect score. The patients before and after cranioplasty and cerebral perfusion index control, analysis of cranioplasty before Ipsilateral and contralateral cerebral cortex, changes in basal ganglia and thalamus CTP indexes. According to the timing of surgery were divided into two groups, ultra early cranioplasty group (January group) and control group (March group), were examined by CTP, collect the specific numerical changes defect area of the cerebral cortex of cerebral blood flow before and after skull defect repair surgery, the changes of the cerebral cortex of CBF defect in two groups were compared before and after surgery; surgery improves neurological deficits in January and March the timing group group patients before and after surgery, postoperative complications, such as changes in the operation process; comparison of epidural hematoma,, brain contusion, hematoma in different primary diseases caused by skull defect repair after cerebral blood flow perfusion. Results cranioplasty preoperative ipsilateral CBF than the healthy side. There was obvious difference in ipsilateral CBF was significantly lower than the healthy side , there were significant differences (P0.05). Postoperative side CBF from preoperative to postoperative from 52.57 + 14.40ml/100g/min 70.55 + 15.00ml/100g/min, there were significant differences (P0.05), and the thalamus, basal ganglia of CBF before surgery, after no obvious change, no significant difference (P0.05) super early skull repair surgery group (1 months after decompression group) and control group (3 months after decompression surgery group) CBF improved significantly, there were statistically significant differences (P0.05). The complications between the two groups, no significant difference was found between the duration of surgery, bleeding, no significant difference (P0.05). Postoperative neurologic deficit scores were improved significantly. There was a significant difference (P0.05). Comparison of different grouping primary disease improvement of CBF had significant difference (P0.05). Conclusion: 1. cranioplasty before the ipsilateral cerebral cortex in a low perfusion state, postoperative hypoperfusion was better to.2. by comparing the ultra early repair group and control Group CBF changes, ultra early repair groups in the ipsilateral cerebral cortex blood perfusion was significantly better than the control group.3. from the nerve function improvement of two groups were compared statistically, ultra early repair group than the control group. The incidence of complications of the two groups of operation time, bleeding comparison, no statistically significant, so the timing of cranioplasty in no obvious contraindications to repair as soon as possible, the patient can maximize the recovery of nerve function of.4. in different primary diseases (epidural hematoma, subdural hematoma, brain contusion, hematoma) patients with skull defect preoperative defect area of cerebral cortex hypoperfusion degree and degree of primary brain injury. There was significant correlation between low perfusion the state of intracerebral hematoma in cerebral contusion and laceration of epidural hematoma, after surgery. The corresponding areas of CBF increase, low perfusion improvement intracerebral hematoma of brain contusion and laceration of epidural hematoma. So, in the brain tissue The more serious the injury patients, in case of no contraindication, more should promote the ultra early cranioplasty.5. ultra early cranioplasty compared to early cranioplasty, timing of surgery is more appropriate, can significantly improve the cerebral blood flow perfusion defect area of cerebral cortex, and thus promote the recovery of neuronal function, reduce the incidence of long-term the neurological deficit and secondary brain injury.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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