标准大骨瓣开颅手术对重型创伤性颅脑损伤所致颅内血肿的临床疗效研究

Research on the clinical efficacy of standard large trauma craniotomy for intracranial hematoma caused by severe traumatic brain injury

目的：探讨标准大骨瓣开颅手术对重型创伤性颅脑损伤所致颅内血肿（sTBI）患者的神经元特异性烯醇化酶（NSE）和炎症因子的影响。方法将64例 sTBI 患者按照奇偶数字法随机分为常规手术组（常规组）与标准大骨瓣开颅手术组（标准组），各32例。比较两组术后格拉斯哥预后评分（GOS）、手术前后血清各炎性因子（IL-8、IL-6、TNF-α、ICAM-1、IL-10）及神经元特异性烯醇化酶（NSE）水平变化情况、术后并发症发生率。结果标准组 GOS 评分情况显著优于常规组（P ＜0．05）；常规组治疗后 IL-6、TNF-α、ICAM-1及 NSE 水平较治疗前均显著降低（P ＜0．05），标准组治疗后 IL-8、IL-6、TNF-α、ICAM-1及 NSE 水平较治疗前均显著降低（P ＜0．05，P ＜0．01），IL-10水平较治疗前显著升高（P ＜0．05）；常规组术后出现3例脑脊液漏、4例切口疝，标准组术后出现2例脑脊液漏、3例切口疝，二者术后并发症发生率比较差异无统计学意义（P ＞0．05）。结论各炎症因子与 NSE 在急性创伤性颅脑损伤过程中均扮演着重要的角色，标准大骨瓣开颅手术可对上述指标进行有效控制，以减小患者病情严重程度。

Objective To investigate the effects of standard large trauma craniotomy on neuron-specific enolase（NSE）inflammatory factors in patients withintracranial hematoma caused by severe trau-matic brain injury（sTBI）.Methods A total of 64 cases of sTBI patients were randomly divided into con-ventional surgery group （conventional group）and standard large trauma craniotomy group （standard group）,with 32 cases in each group.The postoperative Glasgow Outcome Scale（GOS）score,preoperative and postoperativeserum inflammatory factors（IL-8,IL-6,TNF-α,ICAM-1 ,and IL-1 0）,NSE levels,and postoperative complications were compared.Results The GOS score of the standard group was signifi-cantly superior tothe conventional group（P 〈0.05）;postoperativeIL-6,TNF-α,ICAM-1 ,and NSE levels in the conventional group were significantly reduced（P 〈0.05）;postoperativeIL-8,IL-6,TNF-α,ICAM-1 ,and NSE levels were significantly reduced and IL-1 0 levelswassignificantly improvedin the standard group（P 〈0.05）;there were3 cases of postoperative cerebrospinal fluid leakage and four cases of inci-sional hernia in the conventional group,and two cases of postoperative cerebrospinal fluid leakage and three cases of incisional hernia in the standard group;there were no significant differencesin the incidence of postoperative complications in both groups（P 〉0.05 ）.Conclusion Inflammatory factors and NSE both playimportant roles in sTBI.Standard large trauma craniotomycan control these indicators effectively and reduce the severity of the patient＇s illness.