控制性减压一体化策略对重型颅脑创伤患者颅内压、神经递质、血管内皮功能的影响  

Effects of integrated controlled decompression strategy on intracranial pressure,neurotransmitter and vascular endothelial function in patients with severe traumatic brain injury

作　　者：刘炳辉 李鑫[2] 罗志红 Liu Binghui;Li Xin;Luo Zhihong(School of Clinical Medicine,Hunan University of Traditional Chinese Medicine,Changsha Hunan 410036,China;Second Ward of Neurosurgery,Hunan Brain Hospital,Changsha Hunan 410036,China)

机构地区：[1]湖南中医药大学临床医学院,湖南长沙410036 [2]湖南省脑科医院神经外科二病区,湖南长沙410036

出　　处：《中国医刊》2024年第1期65-69,共5页Chinese Journal of Medicine

基　　金：湖南省自然科学基金-科卫联合项目(2021JJ70012)。

摘　　要：目的 探讨控制性减压一体化策略对重型颅脑创伤(STBI)患者颅内压、神经递质、血管内皮功能的影响。方法 选取2020年6月至2022年6月湖南省脑科医院收治的85例STBI患者为研究对象,采用随机数字表法分为控制性减压组(给予控制性减压一体化策略下去骨瓣减压术,43例)和非控制性减压组(给予常规去骨瓣减压术,42例)。比较分析两组患者手术前后的颅内压、格拉斯哥昏迷量表(GCS)评分、神经递质[γ-氨基丁酸(GABA)、天冬氨酸(Asp)]、血流动力学水平[搏动指数(PI)、平均血流速度(Vm)、收缩期最大血流速度(Vs)]、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)]。比较分析两组患者术后7 d的不良反应发生情况以及术后6个月的预后情况。结果 与术前比较,两组患者术后3、7 d的颅内压、Asp、PI、ET-1均降低,GCS评分、GABA、Vm、Vs、NO均升高,差异均有统计学意义(P<0.05)。术后3、7d,控制性减压组患者的颅内压、Asp、PI、ET-1均低于非控制性减压组,GCS评分、GABA、Vm、Vs、NO均高于非控制性减压组,差异均有统计学意义(P<0.05)。术后7 d,控制性减压组患者的不良反应发生率低于非控制性减压组,差异有统计学意义(P<0.05)。术后6个月,控制性减压组患者的预后优于非控制性减压组,差异有统计学意义(P<0.05)。结论 应用控制性减压一体化策略可有效降低STBI患者的颅内压,改善血管内皮功能,促进神经功能恢复及预后改善,且安全性较好。Objective To investigate the effects of integrated controlled decompression strategy on intracranial pressure,neurotransmitter and vascular endothelial function in patients with severe traumatic brain injury(STBI).Method 85 patients with STBI admitted to Hunan Brain Hospital from June 2020 to June 2022 were selected as the study subjects.They were divided into controlled decompression group(with the integrated strategy of controlled decompression,43 cases)and non-controlled decompression group(with routine decompression,42 cases)by random number table method.Intracranial pressure,GCS score,neurotransmitter(GABA,Asp),hemodynamic level(PI,Vm,Vs),endothelial function(NO,ET-1)of the two groups before and after surgery were compared and analyzed.The occurrence of adverse reactions 7 d after surgery and the prognosis 6 months after surgery were compared between the two groups.Result Compared with before surgery,intracranial pressure,Asp,PI and ET-1 in two groups were decreased,while GCS score,GABA,Vm,Vs and NO were increased at 3 d,7 d after surgery,with significant differences(P<0.05).At 3 d,7 d after surgery,intracranial pressure,Asp,PI and ET-1 in the controlled decompression group were lower than those in the non-controlled decompression group,while GCS score,GABA,Vm,Vs and NO were higher than those in the non-controlled decompression group,with significant differences(P<0.05).The incidence of adverse reactions in controlled decompression group was lower than that in non-controlled decompression group at 7 d after surgery,and the difference was significant(P<0.05).6 months after surgery,the prognosis of patients in the controlled decompression group was better than that in the non-controlled decompression group,and the difference was significant(P<0.05).Conclusion The application of integrated controlled decompression strategy can effectively reduce the intracranial pressure in STBI patients,and improve vascular endothelial function,and promote the recovery of neurological function and the prognosis,with good safet

关 键 词：控制性减压一体化策略 重型颅脑创伤 颅内压 神经递质 血管内皮功能 预后 

分 类 号：R651.1[医药卫生—外科学]