标准大骨瓣开颅手术治疗重型创伤性颅脑损伤

Standard large decompressive craniotomy in treatment of severe traumatic brain injury

目的探讨标准大骨瓣开颅手术治疗重型创伤性颅脑损伤（severe traumatic brainin jury，sTBI）所致颅内血肿的临床疗效，并观察其对神经元特异性烯醇化酶（neuron—specific enolase，NSE）和炎症因子的影响。方法将168例sTBI所致颅内血肿患者按治疗方法分为标准大骨瓣开颅手术组（标准组）和传统手术组（对照组），每组各84例。对比患者术后格拉斯哥预后评分（Glasgow outcome scale，GOS）以及血清NSE、TNF—α、IL-6和IL-10水平。结果标准组术后GOS评分显著优于对照组（P〈0．05）。标准组术后血清NSE、TNF-α和IL-6水平显著低于术前（P〈0．05），而IL-10水平显著高于术前（P〈0．05），IL-6／IL-10比值下降，而对照组则无显著改变。标准组平均生存时间为（33．11±0．62）个月，2年和3年生存率均高于对照组。结论标准大骨瓣手术治疗能够提升sTBI所致颅内血肿患者的临床治疗效果，改善患者神经功能缺陷和日常生活能力，降低患者机体炎症应激水平和损伤。

Objective To investigate the clinical effect of standard large decompressive craniotomy in treatment of intraeranial hematoma induced by severe traumatic brain injury （sTBI） and its influence on neuron-specific enolase （NSE） and inflammatory cytokines. Methods A total of 168 patients with sTBI-indueed intraeranial hematoma were assigned to standard large decompressive craniotomy （standard group） and traditional treatment （control group）, with 84 patients per group. Glasgow outcome scale （GOS） and levels of serum NSE, TNF-α, IL-6 and IL-10 were compared between the two groups after surgery. Results GOS was better in standard group than in control group after surgery （P 〈 0.05 ）. Standard group presented significantly lower levels of serum NSE, TNF-α and IL-6 （ P 〈 0.05 ）, significantly higher level of IL-10 （P 〈0.05） and a dropped ratio of IL-6 to IL-10 after surgery. However, there was no significant change in control group. Mean survival time of the patients in standard group was （33.11 ± 0.62 ） months. Two-year and three-year survival rate were significantly higher in standard group than in control group. Conclusion Standard large decompressive eraniotomy cna enhance the clinical effects in patients with sTBI-induced intracranial hematoma, improve their neurologic deficits and daily living ability and decrease their body inflammatory stress level and injury.