• 1 南京鼓樓醫(yī)院集團(tuán)宿遷市人民醫(yī)院神經(jīng)外科（江蘇宿遷，223800）;2 南京大學(xué)醫(yī)學(xué)院附屬南京鼓樓醫(yī)院心血管病中心;3 首都醫(yī)科大學(xué)附屬北京天壇醫(yī)院神經(jīng)介入科;

【摘要】　目的　 探討損傷控制理論（damage control theory，DCT）在腦動(dòng)靜脈畸形（arteriovenous malformations，AVM）診斷與治療中的應(yīng)用意義，以及指導(dǎo)治療腦AVM的可行性。　方法　 依據(jù)DCT原則，對(duì)2007年3月-2009年3月腦AVM患者進(jìn)行積極治療，并分析其治療結(jié)果。　結(jié)果　 根據(jù)DCT原則制訂腦AVM患者的治療方案，控制腦AVM的危險(xiǎn)因素，降低其疾病發(fā)展風(fēng)險(xiǎn)，患者治療結(jié)果比較滿(mǎn)意。　結(jié)論　 應(yīng)用DCT原則指導(dǎo)腦AVM患者急性期處理及介入等治療措施，可以提高患者的生存率，有效控制疾病的危險(xiǎn)因素，提高治療總有效率，具有臨床指導(dǎo)意義。
【Abstract】　Objective　 To investigate the significance and feasibility of damage control theory (DCT) in diagnosing and treating cerebral arteriovenous malformations (AVM).　Methods　 According to the disease treatment principle of DCT, 76 patients with AVM diagnosed in our hospital from March 2007 to March 2009 were treated actively, and the treatment results were analyzed.　Results　 The risk factors of AVM was controlled, the development risk of AVM slowed down, and the therapeutic effect was satisfactory.　Conclusion　 According to the DCT principle, we could improve the survival rate of the patients, control the risk factors effectively, and improve the prognosis of the disease. DCT principle is clinically significant to guide the treatment of AVM.

引用本文： 張建永,張榮林,劉保華,穆士卿,袁璞,高明明. 損傷控制理論在腦動(dòng)靜脈畸形治療中的實(shí)踐與探討. 華西醫(yī)學(xué), 2011, 26(1): 54-56. doi: 復(fù)制

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2. 　Penninga L, Penninga EI, Svendsen LB. Damage control Surgery in multiply traumatised patients[J]. Ugeskr Laeger, 2005, 167(36): 3403-3407.
3. 　Martin A, Schreiber. Damage control surgery[J]. Crit Care Clin, 2004, 20(1): 101-118.
4. 　Kouraklis G, Spirakos S, Glinavou A. Damage control surgery: an alternative approach for the management of critically injured patients[J]. Surg Today, 2002, 32(3): 195-202.
5. 　Batjer HH, Loftus CM. Textbook of neurological surgery. Principles and practice[M]. Philadelphia: Lippincott Williams and Wilkins, 2003: 2543-2569.
6. 　Robert M, Fridlalander MD. Arteriovenous malformations of the brain[J]. N Engl J Med, 2007, 356(26): 2704-2712.
7. 　Weber W, Kis B. Siekmann R. et al. Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects[J]. AJNR Am J Neuroradiol, 2007, 28(2): 371-377.
8. 　李佑祥, 吳中學(xué), 姜鵬, 等. 非粘附性液體栓塞劑Onyx栓塞腦動(dòng)靜脈畸形[J]. 中華神經(jīng)外科雜志, 2006, 22(3): 135-137.
9. 　Norbash AM, Marks MP, Lane B. Correlation of pressure measurements with angiographic characteristics predisposing to hemorrhage and steal in cerebral arteriovenous malformations[J]. AJNR Am J Neuroradiol, 1994, 15(5): 809-813.
10. 　Stapf C, Mohr JP, Pile-Spellman J, et al. Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation[J]. J Neurol Neurosurg Psychiatry, 2002, 73(3): 294-298.
11. 　宋冬雷, 冷冰, 徐斌, 等. 新型液態(tài)栓塞劑栓塞腦動(dòng)靜脈畸形70例經(jīng)驗(yàn)總結(jié)[J]. 中華外科雜志, 2007, 4(45): 223-225.
12. 　Jafar JJ, David AJ, Berenstein A, et al. The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations[J]. J Neurosurg, 1993, 78(1): 60-69.
13. 　趙繼宗, 王碩, 隋大立, 等. 2086例腦動(dòng)靜脈畸形臨床特征和手術(shù)治療結(jié)果分析[J]. 中華神經(jīng)外科雜志, 2004, 20(2): 113-117.
14. 　Massager N, Régis J, Kondziolka D, et al. Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results [J]. J Neurosurg, 2000, 93(Suppl 3): 102-103.
  1. 1. 　Johnson JW, Gracias VH, Schwab CW, et al. Evolution in damage control for exsanguinating penetrating abdominal injury[J]. J Trauma, 2001, 51(2): 261-269.
  2. 2. 　Penninga L, Penninga EI, Svendsen LB. Damage control Surgery in multiply traumatised patients[J]. Ugeskr Laeger, 2005, 167(36): 3403-3407.
  3. 3. 　Martin A, Schreiber. Damage control surgery[J]. Crit Care Clin, 2004, 20(1): 101-118.
  4. 4. 　Kouraklis G, Spirakos S, Glinavou A. Damage control surgery: an alternative approach for the management of critically injured patients[J]. Surg Today, 2002, 32(3): 195-202.
  5. 5. 　Batjer HH, Loftus CM. Textbook of neurological surgery. Principles and practice[M]. Philadelphia: Lippincott Williams and Wilkins, 2003: 2543-2569.
  6. 6. 　Robert M, Fridlalander MD. Arteriovenous malformations of the brain[J]. N Engl J Med, 2007, 356(26): 2704-2712.
  7. 7. 　Weber W, Kis B. Siekmann R. et al. Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects[J]. AJNR Am J Neuroradiol, 2007, 28(2): 371-377.
  8. 8. 　李佑祥, 吳中學(xué), 姜鵬, 等. 非粘附性液體栓塞劑Onyx栓塞腦動(dòng)靜脈畸形[J]. 中華神經(jīng)外科雜志, 2006, 22(3): 135-137.
  9. 9. 　Norbash AM, Marks MP, Lane B. Correlation of pressure measurements with angiographic characteristics predisposing to hemorrhage and steal in cerebral arteriovenous malformations[J]. AJNR Am J Neuroradiol, 1994, 15(5): 809-813.
  10. 10. 　Stapf C, Mohr JP, Pile-Spellman J, et al. Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation[J]. J Neurol Neurosurg Psychiatry, 2002, 73(3): 294-298.
  11. 11. 　宋冬雷, 冷冰, 徐斌, 等. 新型液態(tài)栓塞劑栓塞腦動(dòng)靜脈畸形70例經(jīng)驗(yàn)總結(jié)[J]. 中華外科雜志, 2007, 4(45): 223-225.
  12. 12. 　Jafar JJ, David AJ, Berenstein A, et al. The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations[J]. J Neurosurg, 1993, 78(1): 60-69.
  13. 13. 　趙繼宗, 王碩, 隋大立, 等. 2086例腦動(dòng)靜脈畸形臨床特征和手術(shù)治療結(jié)果分析[J]. 中華神經(jīng)外科雜志, 2004, 20(2): 113-117.
  14. 14. 　Massager N, Régis J, Kondziolka D, et al. Gamma knife radiosurgery for brainstem arteriovenous malformations: preliminary results [J]. J Neurosurg, 2000, 93(Suppl 3): 102-103.