逐步控制性减压手术对急诊老年颅脑外伤患者术后转归的影响  

Effects of stepwise controlled decompression on postoperative outcome of emergency elderly patients with craniocerebral trauma

作　　者：邱珍 何泽会 梁迎 Qiu Zhen;He Zehui;Liang Ying(Department of Critical Care Medicine,Central Hospital of Mianyang City/Mianyang Hospital Affiliated to University of Elec-tronic Science and Technology of China,Mianyang,Sichuan,621000,P.R.China;Department of Rehabilitation Medicine,Central Hospital of Mianyang City/Mianyang Hospital Affiliated to University of Electronic Science and Technology of China,Mianyang,Sichuan,621000,P.R.China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院重症医学科,四川绵阳621000 [2]电子科技大学医学院附属绵阳医院·绵阳市中心医院康复医学科,四川绵阳621000

出　　处：《老年医学与保健》2022年第6期1267-1271,共5页Geriatrics & Health Care

基　　金：四川省医学会重症医学(新晨)专项科研课题(2015ZZ010)。

摘　　要：目的 探究逐步控制性减压术对急诊老年颅脑外伤患者疗效及术后转归的影响。方法 选取2019年2月—2020年9月电子科技大学医学院附属绵阳医院急诊科收治的116例颅脑损伤患者为研究对象,采用非随机对照试验分为观察组(n=58)和对照组(n=58),根据二元Logistic回归方程建立倾向性得分模型,将2组患者进行1∶1匹配,卡钳值为0.02,最终纳入52对基线资料差异无统计学意义的患者。观察组采用逐步控制性减压术,对照组采用标准大骨瓣开颅减压术,2组术后均予以高压氧治疗。观察并比较2组术后1 d、 7 d、 14 d时的血清相关因子水平及围术期并发症发生情况;比较2组术后6个月时的格拉斯哥预后评分(GOS)、 Barthel指数及日常生活基本自理率。结果 术后7 d及14 d时观察组血清ICAM-1、 MMP-9水平均显著低于对照组(P均<0.05),术后7 d时观察组血清S100β蛋白水平显著低于对照组(P<0.05),但术后14 d时2组血清S100β蛋白水平差异无统计学意义(P>0.05)。观察组术中急性脑膨出、血压骤降及术后脑梗死、脑积水、迟发性脑水肿的发生率显著低于对照组(P均<0.05),而2组术中心脏骤停、术后颅内感染的发生率差异均无统计学意义(P>0.05)。术后6个月时,观察组GOS分级情况明显优于对照组,且其预后良好率明显高于对照组(P<0.05);观察组Barthel指数及日常生活基本自理率均显著高于对照组(P均<0.05)。结论 逐步控制性减压术联合高压氧治疗老年颅脑损伤患者,可降低术中颅脑损伤,减少术后并发,促进患者康复。Objective To explore the effects of stepwise controlled decompression on postoperative outcome of emergency elderly patients with craniocerebral trauma. Methods A total of 116 patients with craniocerebral trauma treated in Department of Critical Care Medicine, Mianyang Hospital Affiliated to University of Electronic Science and Technology of China between February 2019 and September 2020 were enrolled as the research subjects. They were divided into observation group(58 cases) and control group(58 cases) by non-randomized controlled trial method. The propensity score model was established according to the binary logistic regression equation. The patients in the two groups were matched 1∶1, and the caliper value was 0.02. Finally, 52 pairs of patients without statistically significant difference in baseline data were included. The observation group was treated with stepwise controlled decompression, and the control group was treated with standard large bone flap craniotomy decompression. Both groups were treated with hyperbaric oxygen after operation. The levels of serum related factors at 1, 7 and 14 days after operation and the incidence of perioperative complications were observed and compared between the two groups. Glasgow Outcome Score(GOS), Barthel Index and basic self-care rate of daily life at 6 months after operation were compared between the two groups. Results The levels of serum ICAM-1 and MMP-9 of the observation group were significantly lower than those of the control group at 7 d and 14 d after surgery(all P<0.05). The serum S100β protein level of the observation group was significantly lower than that of the control group at 7 days after operation(P<0.05), but there was no significant difference in serum S100β protein level between the two groups at 14 days after operation(P>0.05). The incidences of intraoperative acute encephalocele, sudden drop of blood pressure, postoperative cerebral infarction, hydrocephalus and delayed cerebral edema in the observation group were significantly lower than

关 键 词：老年 高压氧 逐步控制性减压术 标准大骨瓣开颅减压术 格拉斯哥预后评分 

分 类 号：R651.15[医药卫生—外科学]