丙泊酚对重型颅脑创伤去骨瓣减压术患者脑血流的影响

doi:10.3969/j.issn.1672-6731.2020.04.016

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (4): 354-358. doi: 10.3969/j.issn.1672-6731.2020.04.016

2 丙泊酚对重型颅脑创伤去骨瓣减压术患者脑血流的影响

任少波, 李立宏

710038 西安, 空军军医大学唐都医院急诊科

收稿日期:2020-04-13 出版日期:2020-04-25 发布日期:2020-04-24
通讯作者: 李立宏,Email:lihongli777@163.com
基金资助:
陕西省重点研发计划重点项目（项目编号：2017ZDXM-SF-042）

Effect of propofol on cerebral blood flow in patients with severe traumatic brain injury undergoing decompression craniectomy

REN Shao-bo, LI Li-hong

Department of Emergency, Tangdu Hospital, Air Force Military Medical University of Chinese PLA, Xi'an 710038, Shaanxi, China

Received:2020-04-13 Online:2020-04-25 Published:2020-04-24
Supported by:
This study was supported by Key Research and Develepment Projects in Shaanxi Province, China (No. 2017ZDXM-SF-042).

摘要/Abstract

摘要：

目的探讨丙泊酚对重型颅脑创伤去骨瓣减压术后患者脑血流的影响。方法选择2015年1月至2018年4月行单侧去骨瓣减压术的重型颅脑创伤患者为观察对象，根据术后镇静药应用情况分为丙泊酚组（30例）和对照组（30例），采用颅内血管超声技术经颞部骨窗监测患侧大脑中动脉平均血流速度（V_mean）和阻力指数（RI），并记录丙泊酚不良反应，出院后6个月通过Glasgow预后分级（GOS）评价长期预后并记录病死率。结果两组患者治疗后患侧大脑中动脉V_mean均低于治疗前（P=0.000），而治疗前后RI差异无统计学意义（P=0.129）；丙泊酚组患者治疗后患侧大脑中动脉V_mean（P=0.000）和RI（P=0.033）均低于对照组。两组GOS评分[（2.37±0.81）分对（2.67±0.76）分；t=1.482，P=0.144]和病死率[4例（13.33%）对2例（6.67%）；校正χ²=0.185，P=0.667]差异无统计学意义。结论丙泊酚通过降低患侧大脑中动脉V_mean和RI而改善重型颅脑创伤患者脑血流，但对长期预后和病死率无明显影响。

关键词: 颅脑损伤, 减压术, 外科, 血流速度, 血管阻力, 二异丙酚

Abstract:

Objective To analyze the effect of propofol on cerebral blood flow (CBF) in patients with severe traumatic brain injury (sTBI). Methods A total of 60 patients of sTBI undergoing unilateral decompression craniectomy in the Department of Neurosurgery from January 2015 to April 2018 were reviewed. Patients were divided into control group (no propofol, but other types of sedatives were used) or propofol group (propofol was used without other types of sedatives), according to whether they were treated with propofol after surgery. Each group contained 30 cases. Before and 2 h after the use of sedative drugs, the mean blood flow velocity (V_mean) and resistivity index (RI) of the affected middle cerebral artery (MCA) were detected by ultrasound through the temporal skull defect, and adverse effects of propofol were recorded. Glasgow Outcome Scale (GOS) was used to evaluate long-term outcome, and mortality was also compared, after a 6 months follow-up. Results The V_mean of the affected MCA was decreased after using sedative in both the 2 groups of patients compared with before using it (P=0.000), and there was no significant difference of RI observed in the affected MCA before and after sedative administration (P=0.129). Compared with the control group, V_mean (P=0.000) and RI (P=0.033) in the MCA of propofol group were decreased after sedative administration. The outcomes of the propofol group and control group were (2.37±0.81) score vs. (2.67±0.76) score (t=1.482, P=0.144) and the mortalities were 4 cases (13.33%) vs. 2 cases (6.67%; adjusted χ²=0.185, P=0.667). Conclusions Propofol can improve CBF in patients with sTBI by reducing V_mean and RI of the affected MCA, but it has no obvious effect on mortality and long-term outcome.

Key words: Craniocerebral trauma, Decompression, surgical, Blood flow velocity, Vascular resistance, Propofol

任少波, 李立宏. 丙泊酚对重型颅脑创伤去骨瓣减压术患者脑血流的影响[J]. 中国现代神经疾病杂志, 2020, 20(4): 354-358.

REN Shao-bo, LI Li-hong. Effect of propofol on cerebral blood flow in patients with severe traumatic brain injury undergoing decompression craniectomy[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(4): 354-358.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I4/354

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2 丙泊酚对重型颅脑创伤去骨瓣减压术患者脑血流的影响

Effect of propofol on cerebral blood flow in patients with severe traumatic brain injury undergoing decompression craniectomy

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