标准大骨瓣减压结合腰大池持续引流术对重型颅脑损伤的疗效与预后的影响  

Efficacy and prognostic effects of standard large bone flap decompression combined with lumbar cistern continuous drainage on patients with severe traumatic brain injury

作　　者：管诚 沈剑虹[2] 管义祥 陈建静 Cheng Guan;Jianhong Shen;Yixiang Guan;Jianjing Chen(Department of Neurosurgery,Haian Hospital Affiliated to Nantong University,Haian 226600,China;Department of Neurosurgery,Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属海安医院神经外科,江苏海安226600 [2]南通大学附属医院神经外科,江苏南通226000

出　　处：《中华神经创伤外科电子杂志》2021年第5期281-287,共7页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：江苏省科研计划项目(Z2019033);2019年南通市市级科技计划项目(JCZ19100);2020年南通市市级科技计划项目(JCZ20112)。

摘　　要：目的探讨大骨瓣减压结合腰大池持续引流术(LCFD)对重型颅脑损伤(sTBI)患者的疗效和安全性。方法选取南通大学附属海安人民医院神经外科自2017年9月至2019年12月收治的86例sTBI患者为研究对象,依据随机数字表法分为单纯大骨瓣组和联合治疗组,每组43例。所有患者均行标准大骨瓣减压术,联合治疗组于术后第3天开始行LCFD,持续引流4 d。于术前至术后第7天连续检测患者颅内压(ICP),评估GOS评分,以及于术前、术后7 d检测白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)和脑脊液S-100B蛋白表达水平以及脑代谢指标[脑灌注压(CPP)、脑氧摄取率(CEO_(2))、颈静脉球部血氧饱和度(SjVO_(2))],随访6个月统计术后并发症以及预后情况。结果联合治疗组术后7 d的治疗有效率显著高于单纯大骨瓣组,差异有统计学意义(χ^(2)=5.103,P=0.037)。术后7 d,联合治疗组ICP较治疗前和单纯大骨瓣组均显著降低,但GOS评分较治疗前和单纯大骨瓣组均显著升高,差异有统计学意义(P<0.05);联合治疗组血清IL-6、hs-CRP水平以及脑脊液S-100B水平较治疗前和单纯大骨瓣组均显著降低,差异有统计学意义(P<0.05);联合治疗组的脑代谢指标水平(CPP、CEO_(2)和SjVO_(2))均显著高于单纯大骨瓣组,差异有统计学意义(P<0.05)。联合治疗组总不良反应发生率(脑积水、颅内感染、硬膜下积液、癫痫)显著低于单纯大骨瓣组,差异有统计学意义(P<0.05)。术后随访6个月,联合治疗组患者昏迷率、死亡率均低于单纯大骨瓣组,差异有统计学意义(P<0.05)。结论标准大骨瓣减压联合LCFD相较于单纯标准大骨瓣减压术更能显著降低sTBI患者的ICP,降低患者机体炎症反应,改善患者脑灌注水平,从而提高患者预后,且不良反应发生率较低。Objective To investigate the efficacy and safety of decompression of large bone flap combined with lumbar cistern continuous drainage(LCFD)in patients with severe traumatic brain injury(sTBI).Methods Eighty six patients with sTBI who were treated in Hai’an Hospital Affiliated to Nantong University from September 2017 to December 2019 were selected as the research objects.According to the random number method,they were divided into simple large bone flap group and combined treatment group with 43 cases in each group.All patients underwent standard large bone flap decompression.LCFD was performed in the combined treatment group on the 3rd day after operation for 4 d.Intracranial pressure(ICP)was continuously measured from preoperative to 7th day after operation and GOS scales were evaluated.Interleukin-6(IL-6)and hypersensitive C-reactive protein(hsCRP)were detected before and 7 d after operation.The levels of S-100B protein in cerebrospinal fluid,brain metabolic[indexes(cerebral perfusion pressure(CPP),cerebral oxygen uptake rate(CEO_(2)),jugular bulb venous oxygen saturation(SjVO_(2))]were observed.The postoperative complications and prognosis were analyzed after 6 months of follow-up.Results The treatment was significantly more efficient 7 d after operation in the combined treatment group than in the simple large bone flap group.The difference was statistically significant(χ^(2)=5.103,P=0.037).Seven day after operation,the ICP in the combined treatment group was significantly reduced compared with both pretreatment and the simple large bone flap group,while the GOS score was significantly higher compared with both pre-treatment and the simple large bone flap group,the difference was statistically significant(P<0.05).The serum IL-6,hs-CRP and cerebrospinal fluid S-100B levels in the combined treatment group were significantly reduced compared with both pretreatment and the simple large bone flap group,the difference was statistically significant(P<0.05).The levels of brain metabolic indexes(CPP,CEO_(2) and SjV

关 键 词：重型颅脑损伤 标准大骨瓣减压术 腰大池持续引流术 颅内压 脑代谢 炎性反应 

分 类 号：R651.15[医药卫生—外科学]