术中实时超声在颅脑损伤手术中的应用

目的 探讨术中超声及超声造影在颅脑损伤手术中的指导作用。方法 2013年10月至2016年9月收治符合标准的重型颅脑损伤85例，按入院时间顺序分为两组，单日为观察组（43例），双日为对照组（42例）。观察组术中使用超声实时引导手术进程及修正手术路径，对照组行常规手术。结果 观察组43例均在超声引导下顺利完成手术，术中超声结合超声造影对颅脑损伤灶发现率达到100%、定位准确率100%，超声测量外伤范围与术前头颅CT所测体积相符。观察组血肿完全清除率明显高于对照组（P<0.05）；观察组术后7 d GCS评分3~8分比例明显低于对照组，而13~15分比例明显高于对照组（P<0.05）；观察组术后脑梗死发生率明显低于对照组（P<0.05）。观察组术后颅内压（17.59±2.1）mmHg]明显低于对照组（20.13±1.5）mmHg；P<0.05]。观察组术后6个月GOS评分明显优于对照组（P<0.05）。观察组术后12个月巴氏指数明显优于对照组（P<0.05）。结论 采用术中超声技术能准确定位外伤灶的数量及位置，有助于彻底清除脑内血肿及无功能脑组织；超声造影可精确判断外伤灶的范围和脑组织的损伤程度，根据实时检查结果指导及时调整手术方式，从而减少脑组织损伤及降低手术并发症的发生，提高手术安全性及治疗效果。

Effects of intraoperative real-time ultrasound on outcomes of operation in the patients with craniocerebral injury

Objective To explore the effects of intraoperative real-time ultrasound on the outcomes in the patients with craniocerebral injury. Methods Of 85 patients with craniocerebral injury, 43 (group A) underwent surgery under guidance of intraoperative real-time ultrasound and 42 (group B) underwent the routine surgery. The curative effects were analyzed and compared between both the groups. Results The rate (90.70%) of complete evacuation of intracranial hematomas was significantly higher in group A than that (28.57.0%) in group B (P<0.05). GCS scores were significantly higher and the rate of postoperative cerebral infarction occurrence was significantly lower in the group A than those in group B 7 days after the operation (P<0.05). The rates of good prognoses were significantly higher in group A than those in group B 6 and 12 months after the operation (P<0.05). Conclusions The ntraoperative real-time ultrasound, which is helpful to accurate determination of the number, position and extent of trauma foci and complete evacuation of hematomas, is beneficial to improvement of operative safety and prognoses in the patients with craniocerebral injury.