颅骨修补手术时机对脑外伤患者炎性应激反应、脑氧代谢及脑神经功能的影响对比  

Comparison of effects of cranioplasty timing on inflammatory stress response and cerebral oxygen metabolism and cerebral nerve function in patients with traumatic brain injury

作　　者：刘家豪 王彦彬 林昌福 LIU Jia-hao;WANG Yan-bing;LIN Chang-fu(Department of Neurosurgery,the Third Peoples Hospital of Henan Provincial Administration,Zhengzhou 450000,China)

机构地区：[1]河南省直第三人民医院神经外科,郑州450000

出　　处：《医药论坛杂志》2025年第5期480-485,共6页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230018)。

摘　　要：目的本研究旨在分析颅骨修补手术时机对脑外伤患者炎性应激反应、脑氧代谢及脑神经功能的影响。方法选择2020年7月—2023年7月于河南省直第三人民医院行去骨瓣减压术治疗的175例脑外伤患者为研究对象,根据其颅骨修补手术时机进行分组,其中去骨瓣减压术后3个月内手术者44例纳入早期组、去骨瓣减压术后3~6个月手术者96例纳入中期组、去骨瓣减压术后6个月后手术者35例纳入晚期组。比较3组患者的临床疗效、炎性应激反应、脑氧代谢及脑神经功能指标及并发症发生情况。结果3组治疗总有效率及总并发症率比较,差异具有统计学意义(P<0.05),总有效率:早期组>中期组>晚期组,总并发症率:早期组<中期组<晚期组(P<0.05)。术后3天、出院时、术后1个月及术后3个月,3组患者肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、内皮醇(cortisol,Cor)、静脉血氧饱和度(SjvO_(2))、桡动脉-颈静脉球部血氧含量差(Da-jvO_(2))、脑氧摄取率(cerebral oxygen uptake rate,CERO_(2))、神经原特异性烯醇化酶(neurogen-specific enolase,NSE)、中枢神经特异性蛋白(CNS specific protein,S100β)、胶质纤维酸性蛋白(glial fibrinous acidic protein,GFAP)水平比较,差异均具有统计学意义,TNF-α、IL-6、Cor、Da-jvO_(2)、CERO_(2)、NSE、S100β、GFAP水平:早期组<中期组<晚期组,SjvO_(2)水平:早期组>中期组>晚期组(P<0.05)。结论早期颅骨修补术用于治疗脑外伤的疗效较好,有助于减少应激反应,改善患者脑氧代谢及神经功能,且术后并发症发生率较低。Objective To analyze the effects of cranioplasty timing on inflammatory stress response,cerebral oxygen metabolism and cerebral nerve function in patients with brain injury.MethodsA total of 175 patients with traumatic brain injury who were admitted to our hospital for craniotomy decompressor from July 2020 to July 2023 were selected as the study subjects and grouped according to the timing of skull repair surgery.Among them,44 patients underwent surgery within 3 months after decompressive craniotomy were included in the early group,96 patients underwent surgery 3-6 months after decompressive craniotomy were included in the middle group,and 35 patients underwent manual surgery 6 months after decompressive craniotomy were included in the late group.The clinical efficacy,inflammatory stress response,cerebral oxygen metabolism,cerebral nerve function and complications of the 3 groups were compared.ResultsThe difference of total effective rate and total complication rate among the three groups was statistically significant,the total effective rate was pairwise compared:early group>middle group>late group,and the total complication rate was pairwise compared:early group<middle group<late group(P<0.05).3 days after surgery,upon discharge,1 month after surgery and 3 months after surgery,the levels of tumor neerosis factor-α(TNF-α),interleukin-6(IL-6),cortisol.(Cor).sagittal jugular bullb venous oxygen saluration(SjvO_(2)),radial arterial-jugular bulbar oxygen content difference(Da-jvO_(2)),cerebral oxygen uptake rate(CERO,),neurogen-specific enolase(NSE),CNS specific protein(SI00β),glial fibrinous acidic protein(GFAP)in 3 groups were compared,and the differences were statistically significant.The level of TNF-α,IL-6,Cor,Da-jvO_(2),CERO_(2),NSE,S100βand GFAP:early group<middle group<late group;the level of SjvO_(2):early group>middle group>late group(P<0.05).Conclusion Early cranioplasty is effective in the treatment of traumatic brain injury,helping to reduce stress response,improve cerebral oxygen metabolism and n

关 键 词：颅骨修补手术 脑外伤 炎性应激反应 脑氧代谢 脑神经功能 

分 类 号：R651.15[医药卫生—外科学]