颅脑损伤意识障碍患者脑脊液总蛋白变化特点  

Characteristics and research value of consciousness disturbance and total protein changes in cerebrospinal fluid after brain injury

作　　者：刘克洪 胡晓华 金晓东[1] 周卫 李冲桥 王红霞[2] LIU Kehong;HU Xiaohua;JIN Xiaodong(Zhejiang Armed Police Corps Hospital,Zhejiang 310051,China)

机构地区：[1]武警浙江总队医院,杭州310051 [2]杭州整形医院

出　　处：《浙江创伤外科》2024年第3期409-411,415,共4页Zhejiang Journal of Traumatic Surgery

基　　金：2020年浙江省卫生科技面上项目(2020363213)。

摘　　要：目的 探讨不同意识障碍患者脑脊液总蛋白的变化特点及其对脑积水的预测价值和治疗评估。方法 选取本院2019年7月至2022年12月收治的200例颅脑损伤意识障碍患者,入院时依据CRS-R评分把患者分为植物状态组和最小意识状态组。所有意识障碍患者每15天行腰穿抽取脑脊液和头颅CT检查,连续6次测量脑脊液总蛋白数值和头颅CT评估。依据患者最终的转归分为脑积水患者和非脑积水患者。通过两组数据对比分析不同意识状态患者脑脊液总蛋白的变化特点及脑积水的发生率;分析脑脊液总蛋白与脑积水的关系,讨论脑脊液总蛋白增高引起脑积水的治疗方法和时机。结果 植物状态组脑脊液总蛋白水平高于最小意识状态组;植物状态组脑积水发生率高于最小意识状态组,脑脊液总蛋白数值在脑积水患者高于非脑积水患者。对发生脑积水患者治疗后脑脊液总蛋白下降,且患者意识状态有明显改善。结论 脑脊液总蛋数值与意识障碍程度成正比,脑脊液总蛋白数值高的患者脑积水发生率高,早期治疗脑积水可以降低脑脊液总蛋白提高预后。Objective To explore the change characteristics of total cerebrospinal fluid protein in patients with different consciousness disor-ders and its predictive value and therapeutic evaluation for hydrocephalus.Methods From July 2019 to December 2022,200 patients with consciousness disorder after craniocerebral injury in our hospital were selected and divided into vegetative state group and minimally conscious state group according to CRS-R score at admission.All patients with consciousness disorder were examined by lumbar puncture and brain CT every 15days,and the total protein value of cerebrospinal fluid and brain CT evaluation were measured 6 times in a row.The patients were divided into hydro-cephalus patients and non hydrocephalus patients according to their final outcome.The change characteristics of CSF total protein and the incidence of hydrocephalus in patients with different states of consciousness were compared and analyzed between the two groups.The relationship between total cerebrospinal fluid protein and hydrocephalus were analyzed,and the treatment method and opportunity of hydrocephalus caused by increased cere-brospinal fluid protein was discussed.Results The total protein level of cerebrospinal fluid in vegetative state group was higher than that in mini-mally conscious state group.The incidence of hydrocephalus in the vegetative state group was higher than that in the minimally conscious state group,and the total protein value of cerebrospinal fluid in hydrocephalus patients was higher than that in non hydrocephalus patients.After treatment,the cerebrospinal fluid protein of patients with hydrocephalus decreased,and their consciousness improved significantly.Conclusion The total protein value of cerebrospinal fluid is in direct proportion to the degree of consciousness disorder.Patients with high total protein value of cerebrospinal fluid have a high incidence of hydrocephalus.Early treatment of hydrocephalus can reduce the total protein of cerebrospinal fluid and improve the prognosis.

关 键 词：颅脑损伤 意识障碍 脑脊液总蛋白 脑积水 

分 类 号：R651.1[医药卫生—外科学]