去骨瓣减压术联合阶梯式减压治疗重型颅脑创伤临床观察  

Clinical observation of decompressive craniectomy combined with stepped decompression in the treatment of severe craniocerebral trauma

作　　者：林锋[1] 宋鹏 梁兴泽[1] LIN Feng;SONG Peng;LIANG Xingze(Guangyuan Central Hospital,Guangyuan 628000,China)

机构地区：[1]广元市中心医院,四川广元628000

出　　处：《中国实用神经疾病杂志》2022年第5期587-592,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省科技支撑计划项目(编号:2015SZ0051);四川大学华西医院卓越发展1.3.5工程项目(编号:ZY2016102)。

摘　　要：目的 探讨去骨瓣减压术联合阶梯式减压治疗方案对重型颅脑创伤患者神经功能的影响。方法 纳入2019-08—2021-11广元市中心医院收治的重型颅脑创伤患者60例,对照组30例采用常规去骨瓣减压术,观察组30例采用去骨瓣减压术联合阶梯式减压治疗。对比2组患者入院时GCS评分、出血量、住院期间并发症、手术效果,统计2组患者血清神经元特异性烯醇化酶(NSE)、NIHSS评分和CD3;、CD4;T淋巴细胞的百分率、CD4;/CD8;比值、血清炎性因子[C反应蛋白(CRP)、白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)]及颅内压(ICP)值。结果 观察组并发症发生率(10.00%)低于对照组(36.67%),恢复良好率高于对照组,重残、植物生存和病死率低于对照组(P<0.05)。术后第1天2组血清NSE水平均较麻醉前降低,NIHSS评分较麻醉前提高,且观察组血清NSE水平低于对照组,NIHSS评分高于对照组(P<0.05)。观察组CD3;、CD4;、CD4;/CD8;高于对照组(P<0.05),术后第1天2组均较麻醉前降低,且观察组血清CRP、IL-6、TNF-α水平低于对照组(P<0.05)。2组患者麻醉前、术后即刻、术后第1天ICP持续下降,且观察组ICP水平低于对照组(P<0.05)。结论 去骨瓣减压术联合阶梯式减压治疗方案有利于控制颅内压,降低炎性因子,减轻术后患者T淋巴细胞抑制程度,改善神经功能及预后。Objective To investigate the effects of decompression combined with stepped decompression on neurological function of patients with severe craniocerebral trauma.Methods A total of 60 patients with severe craniocerebral trauma admitted to our hospital from August 2019 to November 2021 were selected as the research subjects.The control group received routine craniectomy,and the observation group received craniectomy combined with step decompression.GCS score on admission,blood loss,complications during hospitalization and surgical effect were recorded between the two groups.Serum neuron specific enolase(NSE),NIHSS score,percentage of CD3;,CD4;T lymphocyte,ratio of CD4;/CD8;,serum inflammatory factors(C-reactive protein(CRP),interleukin-6(IL-6) and serum tumor necrosis factor-α(TNF-α)) and intracranial pressure(ICP) of two groups were analyzed.Results The incidence of complications in the observation group(10.00%) was lower than that in the control group(36.67%),the rate of good recovery was higher than that in the control group,and the severe disability,plant survival and mortality were lower than that in the control group(P<0.05).CD3;,CD4;,CD4;/CD8;in observation group were higher than those in control group(P<0.05).On the 1 st day after surgery,both groups were lower than before anesthesia,and CRP,IL-6 and TNF-α in observation group were lower than those in control group(P<0.05).ICP in both groups continued to decrease before anesthesia,immediately after surgery and 1 d after surgery,and ICP level in the observation group was lower than that in the control group(P<0.05).Conclusion Decompression combined with step decompression therapy is beneficial to control intracranial pressure,reduce inflammatory factors and the degree of T lymphocyte inhibition,and improve nerve function and the prognosis.

关 键 词：重型颅脑创伤 去骨瓣减压术 阶梯式减压 神经功能 T淋巴细胞 神经元特异性烯醇化酶 颅内压 

分 类 号：R651.15[医药卫生—外科学]