减压术后血管内低温治疗对重症脑损伤患者脑血流动力学及脑损伤标志物的影响  

Effects of intravascular hypothermia therapy after decompression surgery on cerebral hemodynamics and brain injury markers in patients with severe brain injury

作　　者：胡娟 米芷颉 李臻琰[2] HU Juan;MI Zhijie;LI Zhenyan(Department of Critical Care Medicine,Guanghan People's Hospital,Guanghan 618300,Sichuan,China;Department of Neurosurgery,Xiangya Hospital of Central South University,Changsha 410008,Hunan,China)

机构地区：[1]广汉市人民医院重症医学科,四川广汉618300 [2]中南大学湘雅医院神经外科,湖南长沙410008

出　　处：《贵州医科大学学报》2024年第10期1536-1541,1548,共7页Journal of Guizhou Medical University

基　　金：湖南省自然科学基金(2018JJ6139)。

摘　　要：目的探讨减压术后血管内低温治疗对重症脑损伤患者脑血流动力学及脑损伤标志物的影响。方法将采取标准大骨瓣减压术治疗的147例重症颅脑创伤患者根据术后干预方法分为对照组(n=73,手术后采用基础治疗)和研究组(n=74,对照组的基础上加用血管内低温治疗),比较2组患者干预前和干预4周时大脑中动脉收缩期峰值血流速度(PS_(v))、平均血流速度(v_(m))及平均搏动指数(PI)血液动力学指标,检测血清神经元特异性烯醇化酶(NSE)、角质纤维酸性蛋白(GFAP)、S100β蛋白、单核细胞趋化蛋白1(MCP-1)、C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平,评价2组患者的神经功能评分(mRS评分)及生活能力评分(Barthel指数),比较2组患者干预4周时及康复过程中的并发症发生率。结果干预前,2组患者的血清NSE、S100β蛋白、GFAP、MCP-1、CRP、IL-6、TNF-α及大脑中动脉PS_(v)、v_(m)、PI、mRS评分、Barthel指数比较,差异无统计学意义(P>0.05);干预4周时,2组患者血清NSE、S100β蛋白、GFAP、MCP-1、CRP、IL-6、TNF-α、大脑中动脉PI、mRS评分较本组干预前降低,大脑中动脉PS_(v)、v_(m)、Barthel指数较本组干预前升高(P<0.05),研究组的血清NSE、S100β蛋白、GFAP、MCP-1、CRP、IL-6、TNF-α、大脑中动脉PI、mRS评分低于对照组,大脑中动脉PS_(v)、v_(m)、Barthel指数高于对照组,差异具有统计学意义(P<0.05);干预4周时及患者康复过程中,2组患者的并发症发生率比较,差异无统计学意义(P>0.05)。结论标准大骨瓣减压术后血管内低温治疗可改善脑血流动力、有利于减轻重症颅脑创伤患者颅脑损伤程度,促进患者神经功能恢复及术后康复。Objective To explore the value of intravascular hypothermia treatment after standard large bone flap decompression in improving the treatment effectiveness of patients with severe traumatic brain injury.Methods A total of 147 patients with severe traumatic brain injury who underwent standard large bone flap decompression surgery were selected as the study subjects and they were randomly divided into a study group of 74 cases and a control group of 73 cases by a random number table.The control group received basic treatment measures after surgery while the study group received intravascular hypothermia treatment based on the control group.The peak systolic blood flow velocity(PS_(v)),average blood flow velocity(v_(m))and average pulse index(PI)of middle cerebral artery were compared between the two groups before intervention and 4 weeks after intervention.Serum levels of neuron-specific enolase(NSE),keratinocyte acidic protein(GFAP),S100βprotein,monocyte chemotactic protein 1(MCP-1),C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)were detected.The neurological function,daily living activities of the two groups were evaluated and the incidence of complications at 4 weeks of intervention and during rehabilitation were compared between the two groups.Results Before treatment,there was no significant difference in serum NSE,S100βprotein,GFAP,MCP-1,CRP,IL-6,TNF-α,middle cerebral artery PS_(v),v_(m),PI,mRS Scores,and Barthel index between the two groups(P>0.05).After treatment,serum NSE,S100βprotein,GFAP,MCP-1,CRP,IL-6,TNF-α,PI,and mRS Scores of middle cerebral artery in the two groups were significantly decreased compared with those before treatment while PS_(v),v_(m),and Barthel index of middle cerebral artery were significantly increased in the two groups(P<0.05).Serum NSE,S100βprotein,GFAP,MCP-1,CRP,IL-6,TNF-α,PI,and mRS Scores of middle cerebral artery in the study group were lower than those in the control group while PS_(v),v_(m),and Barthel index of middle cerebral artery w

关 键 词：重症颅脑创伤 标准大骨瓣减压 血管内低温治疗 神经功能 日常生活活动能力 

分 类 号：R619[医药卫生—外科学]