着力部位EH清除术与单侧颞额部血肿清除术联合DC对重型对冲性颅脑损伤患者心肌酶谱及预后的影响  

Clinical efficacy of EH removal at the focus site and unilateral temporal frontal hematoma removal combined with DC on myocardial enzyme spectrum and prognosis in patients with severe contre-coup brain injury

作　　者：黄威 HUANG Wei(Department of Neurosurgery,The Fourth People's Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第四人民医院神经外科,河南商丘476100

出　　处：《延边大学医学学报》2025年第1期48-51,共4页Journal of Medical Science Yanbian University

摘　　要：目的:分析着力部位硬膜外血肿(EH)清除术与单侧颞额部血肿清除术联合去骨瓣减压术(DC)治疗重型对冲性颅脑损伤(CCBI)的临床效果及对患者心肌酶谱、预后的影响。方法:回顾性分析2020年7月—2023年4月商丘市第四人民医院收治的71例重型CCBI患者临床资料,根据不同手术方案将其分为两组,其中行着力部位EH清除术联合DC的36例为研究组,行单侧颞额部血肿清除术联合DC的35例为对照组。对比两组的预后、格拉斯哥昏迷量表(GCS)评分、颅内压、对侧血肿厚度、脑中线移位幅度、心肌酶谱[谷草转氨酶(AST)、α羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)]及并发症发生率。结果:研究组预后良好率高于对照组(P<0.05);术后3 d、术后7 d,研究组的GCS评分高于对照组(P<0.05),颅内压低于对照组(P<0.05);术后7 d,研究组的对侧血肿厚度、脑中线移位幅度小于对照组(P<0.05);术后3 d、术后7 d,两组的AST、LDH、α-HBDH水平均比术前降低,且研究组低于对照组(P<0.05);两组并发症发生率对比,差异无统计学意义(P>0.05)。结论:着力部位EH清除术联合DC治疗重型CCBI,可获得良好的预后,降低患者的昏迷程度,降低颅内压,减轻心肌损伤。Objective:To retrospectively analyze the clinical efficacy of epidural hematoma(EH)removal at the focus site and unilateral temporal frontal hematoma removal combined with decompressive craniectomy(DC)in the treatment of severe contre-coup brain injury(CCBI),and their impact on the myocardial enzyme spectrum and prognosis of patients.Methods:The clinical data of 71 patients with severe CCBI treated in the Fourth People's Hospital of Shangqiu from July 2020 to April 2023 were collected and divided into two groups according to different surgical schemes,including 36 cases of EH removal combined with DC as the study group and 35 cases of unilateral temporal frontal hematoma removal combined with DC as the control group.The prognosis,Glasgow coma scale(GCS),intracranial pressure,contralateral hematoma thickness,magnitude of midline cerebral shift,cardiac enzyme profiles[aspartate transaminase(AST),alpha hydroxybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH)],and the rate of complications were compared between the two groups.Results:The good prognosis rate of the study group was higher than that of the control group(P<0.05).The GCS score of the study group was higher than that of the control group at 3 and 7 days after operation(P<0.05),and the intracranial pressure,contralateral hematoma thickness and midline displacement amplitude of the brain were lower than those of the control group(P<0.05).At 3 and 7 days after surgery,AST,LDH andα-HBDH in both groups were lower than those before surgery,and the study group was lower than the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Treatment of severe CCBI with EH removal combined with DC at the focus site can improve the rate of good prognosis,improve the level of coma,reduce intracranial pressure,and reduce myocardial injury.

关 键 词：重型对冲性颅脑损伤 硬膜外血肿清除术 去骨瓣减压术 心肌酶谱 

分 类 号：R651.15[医药卫生—外科学]