渐进减压配合改良大骨瓣减压术对sTBI患者颅内高压及其脑脊液动力学的影响  

Effects of Progressive Decompression Combined with Modified Large Bone Flap Decompression on Intracranial Hypertension and Cerebrospinal Fluid Dynamics in Patients with sTBI

作　　者：黄国骥 HUANG Guoji(Yudu County People's Hospital,Jiangxi Province,Yudu 342300,China)

机构地区：[1]江西省于都县人民医院,江西于都342300

出　　处：《中国医学创新》2023年第30期62-66,共5页Medical Innovation of China

摘　　要：目的:基于颅内高压及脑脊液动力学情况探析渐进减压配合改良大骨瓣减压术(MLBFD)治疗重型颅脑损伤(sTBI)的效果。方法:选取2018年7月—2022年6月于都县人民医院神经外科收治的sTBI患者72例,随机分为对照组和观察组,各36例。两组均行MLBFD,对照组使用常规减压,观察组行渐进减压,比较两组手术前后颅内压、脑脊液动力学、血清学指标的差异性,并对治疗安全性和患者的预后进行评价。结果:与术前比较,术后1、3、5 d两组颅内压均下降(P<0.05),且观察组术后1、3、5 d的颅内压均较对照组更低(P<0.05)。术后5 d,观察组足向流动(收缩期)终止时间(SE)、超氧化物歧化酶(SOD)水平均高于对照组,足向流动(收缩期)最大流速(MSV)、头向流动(舒张期)最大流速(MDV)、神经元特异性烯醇化酶(NSE)、一氧化氮(NO)、内皮素(ET)、脑钠肽(BNP)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物-1(PAI-1)均低于对照组(P<0.05)。观察组术后并发症发生率为6.25%,较对照组的25.00%更低(P<0.05)。两组术后3个月恢复良好率分别为62.50%和87.50%,观察组较对照组更高(P<0.05)。结论:渐进减压配合MLBFD可帮助sTBI患者降低颅内压,改善脑脊液动力学情况,降低血清因子水平,促进预后,较为安全。Objective:To explore the effect of progressive decompression combined with modified large bone flap decompression(MLBFD)on severe traumatic brain injury(sTBI)based on intracranial hypertension and cerebrospinal fluid dynamics.Method:A total of 72 patients with sTBI admitted to the Neurosurgery Department of Yudu County People's Hospital from July 2018 to June 2022 were randomly divided into the control group and the observation group,with 36 cases each.Both groups were treated with MLBFD,the control group was treated with conventional decompression,and the observation group was treated with progressive decompression.The differences of intracranial pressure,cerebrospinal fluid dynamics,and serological indexes between the two groups before and after surgery were compared,and the treatment safety and prognosis of patients were evaluated.Result:Compared with before operation,the intracranial pressure of the patients in the two groups decreased on the 1st,3rd and 5th day after operation(P<0.05),and the levels of intracranial pressure in the observation group were lower than those in the control group on the 1st,3rd and 5th day after operation(P<0.05).Five days after surgery,the end time of foot flow(systole)(SE)and the level of superoxide dismutase(SOD)in the observation group were higher than those in the control group,maximum foot flow(systole)velocity(MSV),maximum head flow(diastole)velocity(MDV),serum neuron specific enolase(NSE),nitric oxide(NO),endothelin(ET),serum brain natriuretic peptide(BNP),tissue type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1)in the observation group were all lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 6.25%,which was lower than 25.00%in the control group(P<0.05).The good recovery rates of the two groups at 3 months after operation were 62.50%and 87.50%respectively,and that of the observation group was higher than that of the control group(P<0.05).Conclusion:Progressive decompression combi

关 键 词：重型颅脑损伤 渐进减压 改良大骨瓣减压 颅内压 脑脊液 

分 类 号：R651.15[医药卫生—外科学]