双侧去骨瓣减压术治疗重型对冲性脑损伤患者的疗效及安全性分析  

Efficacy and Safety Analysis of Bilateral Decompressive Craniectomy in Patients with Severe Hedging Brain Injury

作　　者：张会涛 ZHANG Hui-tao(Department of Critical Care Medicine,Changyuan People’s Hospital,Changyuan,Henan,453400,China)

机构地区：[1]长垣市人民医院重症医学科,河南长垣453400

出　　处：《黑龙江医学》2022年第6期695-697,共3页Heilongjiang Medical Journal

摘　　要：目的:探究重型对冲性脑损伤(CCBI)患者经双侧去骨瓣减压术治疗的疗效及安全性。方法:选取长垣市人民医院于2019年1月—2020年2月收治的74例重型对冲性脑损伤患者作为研究对象,根据手术方案不同分组,每组各37例。对照组采用标准单侧外伤大骨瓣减压术,观察组采用双侧去骨瓣减压术。对比两组患者疗效、术中脑膨出、术后切口疝发生率、术后1d、3d、7d颅内压及术前、术后7d血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、神经元特异性烯醇化酶(NSE)、S-100β水平。结果:观察组总有效率高于对照组,差异有统计学意义(χ^(2)=4.893,P<0.05);观察组术中脑膨出、术后切口疝发生率低于对照组,差异有统计学意义(χ^(2)=17.458、14.352,P<0.05);观察组术后1d、3d、7d颅内压低于对照组,差异有统计学意义(t=8.942、13.820、13.943,P<0.05);术后7 d观察组血清TNF-α、IL-6水平低于对照组,差异有统计学意义(t=4.413、7.542,P<0.05);术后7d观察组血清NSE、S-100β水平低于对照组,差异有统计学意义(t=5.501、7.332,P<0.05)。结论:双侧去骨瓣减压术治疗重型对冲性脑损伤患者,可降低颅内压,减少脑膨出和切口疝发生,降低血清炎症因子与神经因子水平,效果显著。Objective:To investigate the efficacy and safety of bilateral decompressive craniectomy in patients with severe hedging brain injury (CCBI).Methods:A total of 74 patients with severe hedging brain injury admitted to the hospital from January2019 to February 2020 were selected and grouped according to different surgical plans, with 37 cases in each group. The control group was treated with standard unilateral trauma decompressive craniectomy, and the observation group was treated with bilateral decompressive craniectomy. The curative effect, intraoperative encephalocele, postoperative incisional hernia incidence, intracranial pressure at 1 d, 3 d, and 7 d after operation and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), neuron-specific enolase (NSE) and S-100β levels before and 7 d after operation were compared between the two groups.Results:The total effective rate in the observation group was higher than that in the control group, with statistically significant difference (χ^(2)=4.893, P<0.05). The incidences of intraoperative encephalocele and postoperative incisional hernia in the observation group were lower than those in the control group, with statistically significant difference (χ^(2)=17.458, 14.352, P<0.05). The intracranial pressure of the observation group was lower than that of the control group at 1 d, 3 d and 7 d after operation, with statistically significant difference(t=8.942, 13.820, 13.943, P<0.05). The serum levels of TNF-α and IL-6 in the observation group were lower than those in the control group at 7 d after operation, with statistically significant difference (t=4.413, 7.542, P<0.05). The serum levels of NSE and S-100β in the observation group were lower than those in the control group 7 d after operation, with statistically significant difference(t=5.501, 7.332, P<0.05).Conclusion:Bilateral decompressive craniectomy in the treatment of patients with severe hedging brain injury can reduce intracranial pressure, reduce the occurrence of encephalocele and incisional he

关 键 词：重型对冲性脑损伤 双侧去骨瓣减压术 脑膨出 切口疝 炎症因子 神经因子 

分 类 号：R651.1[医药卫生—外科学]