超低位去大骨瓣术联合亚低温治疗重症颅脑损伤  

Super low large bone flap removal combined with mild hypothermia in the treatment of severe craniocerebral injury

作　　者：韩利彦 李静 曹亚哲 王东 HAN Liyan;LI Jing;CAO Yazhe;WANG Dong(Shijiazhuang People’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市人民医院,河北石家庄050000

出　　处：《中国实用神经疾病杂志》2022年第11期1361-1366,共6页Chinese Journal of Practical Nervous Diseases

基　　金：石家庄市科学技术研究与发展计划项目(编号:211460793)。

摘　　要：目的观察超低位去大骨瓣术联合亚低温治疗重症颅脑损伤患者的临床疗效。方法回顾性分析2019-01—2022-01石家庄市人民医院治疗的100例颅脑损伤患者的一般资料,对照组和联合组各50例。对照组予以超低位去大骨瓣术治疗,联合组采用超低位去大骨瓣术+亚低温治疗,比较2组临床疗效、认知功能、颅脑损伤程度、炎性细胞因子,血清胶质纤维酸性蛋白(GFAP)、S100B蛋白(S100B)、血小板反应蛋白1(TSP-1)水平,观察并发症发生情况。结果联合组临床总有效率(94.00%)明显高于对照组(80.00%,P<0.05)。联合组治疗7 d后GFAP、S100B、TSP-1水平较同期对照组更低(P<0.05),肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平明显低于同期对照组(P<0.05)。联合组术后3个月简易智能精神状态检查量表(MMSE)、格拉斯哥昏迷量表(GCS)评分较对照组提高更明显(P<0.05)。联合组总并发症发生率明显低于对照组(4.00%vs 18.00%,χ^(2)=5.005,P=0.025)。结论超低位去大骨瓣术联合亚低温治疗可降低颅脑损伤患者血清GFAP、S100B、TSP-1及炎症水平,促进患者脑神经功能恢复,改善其认知功能,疗效确切且安全性高。Objective To observe the clinical efficacy of super low large bone flap removal combined withmild hypothermia in the treatment of severe craniocerebral injury.Methods The general data of 100 patientswith brain injury admitted to Shijiazhuang People’s Hospital from January 2019 to January 2022 were retrospec-tively analyzed.They were divided into the reference group(50 cases)and the combined group(50 cases).Thereference group was treated with ultra-low large bone flap removal,and the combined group was treated with ul-tra-low large bone flap removal+mild hypothermia.The clinical efficacy,cognitive function,degree of traumaticbrain injury,inflammatory cytokines,and serum GFAP,S100B,TSP-1 levels and complications were compared be-tween the two groups.Results The total clinical effective rate of the combined group(94.00%)was significantlyhigher than that of the reference group(80.00%,P<0.05).After 7 days of treatment,the levels of GFAP,S100Band TSP-1 in the combined group were significantly lower than those in the control group(P<0.05).Seven daysafter treatment in combination group tumor necrosis factor-α(TNF-α),the levels of interleukin-6(IL-6)and inter-leukin-8(IL-8)were significantly lower than those of the control group(P<0.05).The scores of MMSE and GCSin the combined group were significantly improved 3 months after operation(P<0.05).The total complication rate in the combined group was significantly lower than that of the reference group(4.00%vs 18.00%,χ~2=5.005,P=0.025).Conclusion Ultra-low large bone flap removal combined with mild hypothermia treatment can reduce thelevels of serum GFAP,S100B,TSP-1 and inflammation in patients with brain injury,and promote the recovery ofbrain nerve function and improve their cognitive function.It is effective and safe.

关 键 词：颅脑损伤 超低位去大骨瓣术 亚低温 胶质纤维酸性蛋白 血小板反应蛋白1 S100B蛋白 肿瘤坏死因子-α 白细胞介素-6 白细胞介素-8 

分 类 号：R651.15[医药卫生—外科学]