本文選題：CT腦灌注成像　切入點(diǎn)：顱骨修補(bǔ)術(shù)　出處：《蘭州大學(xué)》2015年碩士論文

【摘要】：目的通過(guò)CT灌注(CT perfusion,CTP)技術(shù)檢測(cè)顱骨修補(bǔ)術(shù)前后顱骨缺損區(qū)大腦皮層腦血流灌注變化情況,研究不同手術(shù)時(shí)期、不同原發(fā)病進(jìn)行顱骨缺損修補(bǔ)腦灌注各指標(biāo)間的關(guān)系,了解超早期修補(bǔ)在改善腦灌注等方面的優(yōu)越性,為臨床更好地把握顱骨修補(bǔ)時(shí)機(jī)和治療提供理論依據(jù)。方法本研究對(duì)象為38例去骨瓣減壓術(shù)后1-6個(gè)月病人,男26例,女12例,年齡在20～61歲之間,平均41歲。其中交通事故傷25例,墜落傷8例,高血壓腦出血5例。分別于顱骨修補(bǔ)術(shù)術(shù)前2天和術(shù)后第15天采用64層螺旋CT行腦灌注掃描一次,并同步行神經(jīng)功能缺失評(píng)分。將患者顱骨修補(bǔ)手術(shù)前后腦灌注指標(biāo)對(duì)照,分析顱骨修補(bǔ)術(shù)前后患側(cè)和健側(cè)大腦皮層、基底節(jié)區(qū)和丘腦CTP各指標(biāo)變化規(guī)律。按照手術(shù)時(shí)機(jī)選擇分為兩組,超早期顱骨修補(bǔ)組(1月組)和對(duì)照組(3月組),通過(guò)CTP檢查,收集顱骨缺損修補(bǔ)手術(shù)前后缺損區(qū)大腦皮層腦血流量的變化的具體數(shù)值,比較兩組患者手術(shù)前后缺損區(qū)大腦皮層CBF變化情況;比較手術(shù)時(shí)機(jī)選擇1月組和3月組手術(shù)的患者術(shù)前及術(shù)后神經(jīng)功能缺失改善情況、術(shù)后手術(shù)并發(fā)癥發(fā)生率、手術(shù)過(guò)程中情況等變化情況；比較硬腦膜外、下血腫、腦挫裂傷、腦內(nèi)血腫等不同原發(fā)病導(dǎo)致的顱骨缺損,修補(bǔ)術(shù)前后腦皮層血流灌注情況。結(jié)果顱骨缺損修補(bǔ)術(shù)術(shù)前患側(cè)CBF較健側(cè)有明顯差異,患側(cè)CBF明顯低于健側(cè),有統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后患側(cè)CBF從術(shù)前從52.57±14.40ml/100g/min增至術(shù)后70.55±15.00ml/100g/min,有統(tǒng)計(jì)學(xué)差異(P0.05),而丘腦、基底節(jié)CBF術(shù)前、后無(wú)明顯變化,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)超早期顱骨修補(bǔ)組(減壓術(shù)后1個(gè)月手術(shù)組)和對(duì)照組(減壓術(shù)后3個(gè)月手術(shù)組)CBF有明顯改善,有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組間并發(fā)癥發(fā)生、手術(shù)歷時(shí)、出血等情況比較無(wú)明顯差異,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后神經(jīng)功能缺失評(píng)分較術(shù)前明顯改善,有明顯統(tǒng)計(jì)學(xué)差異(P0.05)。不同原發(fā)病分組比較CBF改善情況有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.顱骨修補(bǔ)術(shù)前患側(cè)大腦皮層處于低灌注狀態(tài),術(shù)后低灌注狀態(tài)明顯好轉(zhuǎn)。2.通過(guò)比較超早期修補(bǔ)組和對(duì)照組CBF變化情況,超早期修補(bǔ)組患側(cè)大腦皮層血液灌注明顯優(yōu)于對(duì)照組。3.從神經(jīng)功能改善情況比較兩組統(tǒng)計(jì)學(xué)差異,超早期修補(bǔ)組明顯優(yōu)于對(duì)照組。兩組并發(fā)癥發(fā)生率、手術(shù)時(shí)間、出血對(duì)比,沒(méi)有明顯統(tǒng)計(jì)學(xué)意義,故顱骨缺損修補(bǔ)手術(shù)時(shí)機(jī)在無(wú)明顯禁忌癥的情況下盡早修補(bǔ),能使患者最大程度恢復(fù)神經(jīng)功能。4.不同原發(fā)病(硬腦膜外血腫、硬腦膜下血腫、腦挫裂傷、腦內(nèi)血腫)患者顱骨缺損術(shù)前缺損區(qū)大腦皮層低灌注程度與原發(fā)腦損傷程度有明顯相關(guān)性。即低灌注狀態(tài)腦內(nèi)血腫腦挫裂傷硬腦膜外、下血腫。術(shù)后對(duì)應(yīng)區(qū)CBF增加,低灌注改善程度腦內(nèi)血腫腦挫裂傷硬腦膜外、下血腫。所以,在腦組織損傷越嚴(yán)重的患者,在無(wú)手術(shù)禁忌的情況下,越應(yīng)該提倡超早期行顱骨缺損修補(bǔ)術(shù)。5.超早期顱骨修補(bǔ)相比起早期的顱骨修補(bǔ)來(lái)說(shuō),手術(shù)時(shí)機(jī)更加合適,能明顯改善缺損區(qū)大腦皮層的腦血流灌情況,進(jìn)而促進(jìn)神經(jīng)元功能恢復(fù),減少遠(yuǎn)期神經(jīng)功能缺失和繼發(fā)性腦損害的發(fā)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.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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