高压氧辅助标准大骨瓣开颅术对重型颅脑损伤患者血流动力学及血清炎性因子的影响

Effect of hyperbaric oxygenation assisted standard large craniotomy on hemodynamics and serum inflammatory factors of patients with severe traumatic brain injury

目的探究高压氧辅助标准大骨瓣开颅术对重型颅脑损伤(STBI)患者血流动力学及血清炎性因子的影响。方法选取2014年6月—2015年6月重型颅脑损伤致颅内出血患者56例,采用随机数字表法分为2组,每组28例。对照组给予常规骨瓣开颅术治疗,观察组实施标准大骨瓣开颅术联合高压氧治疗。检测对比2组血流动力学指标、代谢状态指标水平,并采用格拉斯哥预后量表(GOS)评估2组术后6个月预后情况。结果观察组术后1周、术后1个月时CBF、CBV水平显著高于对照组(P<0.05),TTP、MTT水平显著低于对照组(P<0.05);而术后1个月时,对照组CBF、CBV、TTP、MTT水平较术后1周时明显变化(P<0.05)。观察组术后5 d时TNF-α、IL-2水平较术前显著降低(P<0.05),IL-4水平较术前显著升高(P<0.05),且效果优于对照组(P<0.05)。2组术后5 d时RBP、TRE、PA水平较术前显著降低(P<0.05),CEO2、SVO2水平较术前显著升高(P<0.05);且观察组术后5 d时RBP、TRE、PA、CEO2、SVO2水平显著高于对照组(P<0.05)。观察组半年预后良好率(42.7%)明显优于对照组(14.3%,P<0.05)。结论标准大骨瓣开颅术联合高压氧治疗重型颅脑损伤患者,可有效稳定患者血流动力学,改善炎症、改善代谢状态,提高预后。

Objective To investigate the effect of hyperbaric oxygenation assisted standard large craniotomy on hemodynamics and serum inflammatory factors of patients with severe traumatic brain injury（ STBI）. Methods Fifty-six severe traumatic brain injury patients with intracranial hemorrhage from June,2014 to June,2015 were randomly divided into 2groups,each 28 cases. The control group was treated with standard large craniotomy,the observation group was treated with standard large craniotomy combined with hyperbaric oxygen therapy. The hemodynamics[cerebral blood flow（ CBF）,time to peak（ TTP）,mean transit time（ MTT）,cerebral blood volume（ CBV）,inflammatory factor tumor necrosis factor alpha（ TNF-α） and interleukin-4（ IL-4）,IL-2] and metabolic status indicators（ brain metabolism,protein metabolism） were made detection and comparison. And the glasgow prognosis scale（ GOS） was used to evaluate the prognosis of both groups. The hemodynamic and metabolic parameters of the two groups were compared. And the GOS was used to evaluate the prognosis of both groups. Results The levels of CBF and CBV in the observation group were significantly higher than those in the control group at 1 week and 1 month after operation（ P〈0. 05）. The levels of TTP and MTT in the observation group were significantly lower than those in the control group（ P〈0. 05）. The level of CBF,CBV,TTP and MTT in the control group was significantly higher than that in the control group at 1 month after operation（ P〈0. 05）. The levels of TNF-α and IL-2 in the observation group were significantly lower than those before operation（ P〈0. 05） and the levels of IL-4 were significantly higher than those before operation（ P〈0. 05）. And the effect was better than the control group（ P〈0. 05）. The levels of RBP,TRE and PA in the two groups were significantly lower than those before operation（ P〈0. 05）,and the levels of CEO2 and SVO2were significantly higher than those before operation（ P〈0. 05）; The levels of RBP,TRE,PA,CEO2,SVO2 in the observation group were significantly higher than those in the control group at 5 days（ P〈0. 05）. The good prognosis rate（ 42. 7%） in the observation group was significantly better than that in the control group（ 14. 3%）,P〈0. 05. Conclusion Standard large craniotomy combined with hyperbaric oxygen therapy can improve the serum inflammatory factors and hemodynamics in patients with severe head injury,and can improve the prognosis and improve the metabolic status of patients.