颅内压监测下阶梯减压术治疗重症颅脑损伤的临床疗效  

Clinical effect of stepwise decompression under intracranial pressure monitoring in the treatment of severe head injury

作　　者：谢超[1] 李煜华[1] 杨正刚[1] XIE Chao;LI Yuhua;YANG Zhenggang(Department of Neurosurgery,Songzi People's Hospital,Songzi,Hubei 434200,China)

机构地区：[1]松滋市人民医院神经外科,湖北省松滋市434200

出　　处：《中南医学科学杂志》2022年第3期438-441,共4页Medical Science Journal of Central South China

摘　　要：目的 观察颅内压监测下阶梯减压术治疗重症颅脑损伤的临床疗效。方法 回顾性选取86例重症颅脑损伤患者,按不同手术方式分别纳入阶梯减压组和常规减压组,常规减压组给予常规大骨瓣减压术治疗,阶梯减压组给予颅内压监测下阶梯减压术治疗。比较两组临床疗效、格拉斯哥昏迷评分(GCS)、美国国立卫生院卒中量表(NIHSS)评分、简易精神状态量表(MMSE)评分、日常生活能力(ADL)评分、血清白细胞介素-6(IL-6)水平、神经元特异性烯醇化酶(NSE)水平、肿瘤坏死因子-α(TNF-α)、前蛋白(PA)水平以及并发症发生情况。结果 阶梯减压组临床有效率高于常规减压组(P<0.05)。阶梯减压组术后GCS、NIHSS、MMSE、ADL评分,以及术后血清IL-6、NSE、TNF-α、PA水平等均优于常规减压组(P<0.05)。阶梯减压组并发症发生率低于常规减压组(P<0.05)。结论颅内压监测下阶梯减压术治疗重症颅脑损伤患者临床效果显著,并发症发生减少,有利于良好预后。Aim To observe the clinical effect of stepwise decompression under intracranial pressure monitoring in the treatment of severe head injury. Methods A total of 86 patients with severe head injury were retrospectively selected. According to the patient’s condition and the intention of their family members, the patients were divided into stepwise decompression group and conventional decompression group according to the surgical method, 43 cases in each group.The conventional decompression group was treated with conventional large decompressive craniectomy, and the stepwise de-compression group was treated with stepwise decompression under intracranial pressure monitoring. The clinical effects,glasgow coma score( GCS) scores, national institutes of health stroke scale( NIHSS) scores, mini mental stateexamination scale(MMSE) scores, activity of daily living(ADL) scores, levels of serum interleukin-6(IL-6), neuron-specific enolase(NSE), tumor necrosis factor-α(TNF-α) and prealbumin(PA), and complications were compared be-tween the two groups. Results The clinical response rate in stepwise decompressiongroup was higher than that in con-ventional decompression group(P<0. 05). After operation, the GCS, NIHSS, MMSE and ADL scores, serum IL-6,NSE, TNF-α and PA levels in stepwise decompression group were better than those in conventional decompression group(P<0. 05). The incidence of complications in stepwise decompression group was lower than that in conventional decom-pression group(P<0. 05). Conclusion Stepwise decompression under intracranial pressure monitoring is effective inthe treatment of patients with severe head injury, with few complications, which is conducive to the prognosis.

关 键 词：重症颅脑损伤 颅内压监测下阶梯减压术 常规大骨瓣减压术 

分 类 号：R651.15[医药卫生—外科学]