高压氧辅助改良去大骨瓣减压术对重型颅脑创伤患者脑血流指标、血清炎性因子及生活质量的影响  

Effects of hyperbaric oxygen-assisted modified large bone flap decompression on cerebral blood flow,serum inflammatory factors and quality of life in patients with severe traumatic brain injury

作　　者：黄琼 董恒[1] 邓娟 HUANG Qiong;DONG Heng;DENG Juan(The Second Affiliated Clinical Hospital of North Sichuan Medical College,Nanchong Central Hospital,Nanchong,Sichuan637000,China)

机构地区：[1]川北医学院附属第二临床医院南充市中心医院

出　　处：《创伤外科杂志》2019年第10期778-783,共6页Journal of Traumatic Surgery

摘　　要：目的探讨高压氧辅助改良去大骨瓣减压术对重型颅脑创伤(STBI)患者脑血流指标、血清炎性因子及生活质量的影响。方法2015年10月—2018年2月川北医学院附属第二临床医院治疗212例STBI患者,其中男性123例,女性89例,年龄37~52岁,平均43.55岁。根据随机数字表法将其分为A组(n=53,采用标准去大骨瓣减压术治疗)、B组(n=54,采用改良去大骨瓣减压术治疗)、C组(n=52,采用高压氧辅助改良去大骨瓣减压术治疗)、D组(n=53,采用高压氧辅助标准去大骨瓣减压术治疗)。高压氧治疗于HY3400型大型高压氧舱内进行,1次/d,6次/周,共治疗3个月。比较四组临床疗效、脑血流指标、血清炎性因子、生活质量以及并发症发生情况。结果C、D组总有效率高于A组和B组(P<0.05)。B、C、D组患者治疗3、5、10d后大脑中动脉收缩期峰值流速(Vs)、平均血流速度(Vm)高于A组同时间点,且C、D组高于B组(P<0.05),而搏动指数(PI)低于A组同时间点,且C、D组低于B组(P<0.05)。B、C组患者治疗7d后白介素-2(IL-2)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)水平均低于A组,且C、D组低于B组(P<0.05)。B、C组患者治疗7d后健康状况、精神状态、社会功能以及躯体疼痛评分均高于A组,且C、D组高于B组(P<0.05)。四组患者迟发型血肿、间质性脑水肿、脑积水的发生率差异有统计学意义(P>0.05),B、C组患者急性脑膨出、切口氙的发生率显著低于A组,且C、D组低于B组(P<0.05)。除D组急性脑膨出、切口氙的发生率显著高于C组(P<0.05)外,C、D组其他各观察指标差异均无统计学意义(P>0.05)。结论高压氧辅助改良去大骨瓣减压术治疗STBI疗效确切,可有效改善患者脑部血流,降低炎性反应,改善患者生活质量,同时还可降低急性脑膨出、切口氙等并发症的发生率。Objective To investigate the effects of hyperbaric oxygen-assisted modified large bone flap decompression on cerebral blood flow,serum inflammatory factors and quality of life in patients with severe traumatic brain injury(STBI).Methods Totally 212 STBI patients who were treated in our hospital from Oct.2015 to Feb.2018 were selected,123 males and 89 females were aged from 37 to 52 years,with an average age of 43.55 years.They were randomly divided into group A(n=53,treated with standard decompression),group B(n=54,treated with modified decompression),group C(n=52,treated with hyperbaric oxygen assisted modified decompression),and Group D(n=53,treated with hyperbaric oxygen assisted standard decompression of large bone flap)according to digital table method.Hyperbaric oxygen therapy was performed in HY3400 large hyperbaric oxygen chamber,1 time/d,6 times/week,for a total of 3 months.The clinical efficacy,cerebral blood flow indexes,serum inflammatory factors,quality of life and complications were compared among the four groups.Results The total effective rate of group C,group D was higher than that of group A and group B(P<0.05).The peak systolic velocity(Vs)and mean blood flow velocity(Vm)of middle cerebral artery in group B,group C,and group D at 3d,5d and 10d after treatment were higher than those of group A at the same time point,and those in group C,group D were higher than those in the group B(P<0.05).The pulsatility index(PI)in group B,group C,and group D were lower than in group A at the same time point,and those in group C,and group D were lower than those in group B(P<0.05).The levels of interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and hypersensitivity C reactive protein(hs-CRP)in group B,group C,and group D at 7d after treatment were lower than those in group A,and those in group C,group D were lower than those in the group B(P<0.05).The health status,mental status,social function and body pain scores in group B,group C,and group D at 7d after treatment were higher than those

关 键 词：颅脑创伤 高压氧 去大骨瓣减压术 脑血流 炎性因子 

分 类 号：R651.1[医药卫生—外科学]