标准大骨瓣减压术对重型颅脑损伤患者免疫功能、颅内压及预后的影响

Effect of Standard Large Craniotomy on Immune Function,Intracranial Pressure and Prognosis of Patients with Severe Craniocerebral Injury

目的探讨标准大骨瓣减压术对重型颅脑损伤患者免疫功能、颅内压及预后的影响。方法选取2014年1月—2020年1月本院收治的90例重型颅脑损伤患者,根据手术方法的不同均分为观察组(标准大骨瓣减压术)和对照组(常规骨瓣开颅术),比较2组手术前后免疫功能指标、相关因子、颅内压、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分及术后并发症发生情况,并对2组进行为期6个月的随访,了解其预后情况。结果术后,2组CD4+、CD4+/CD8+、前白蛋白较术前升高,CD8+、髓鞘碱性蛋白、超敏C反应蛋白、颅内压及NIHSS评分较术前降低,且以观察组改善更为明显,差异有统计学意义(P<0.05或P<0.01)。观察组术后并发症总发生率明显低于对照组,差异有统计学意义(P<0.05)。术后随访6个月,观察组植物生存率低于对照组,恢复良好率明显高于对照组,差异有统计学意义(P<0.05)。结论采用标准大骨瓣减压术治疗重型颅脑损伤,可改善患者免疫功能及炎性状态,对降低患者颅内压水平、改善预后有重要意义。

Objective To investigate the effect of standard large craniotomy on immune function,intracranial pressure and prognosis of patients with severe craniocerebral injury(SCCI).Methods A total of 90 patients with SCCI treated in our hospital from January 2014 to January 2020 were selected and divided into observation group(standard large craniotomy)and control group(conventional craniotomy)according to different surgical methods.The immunological function index,related factors,intracranial pressure and National Institute of Health Stroke Scale(NIHSS)score before and after operation as well as postoperative complications were compared between the two groups.All patients were followed up for 6 months to understand the prognosis.Results After operation,the levels of CD4+,CD4+/CD8+,and prealbumin in the two groups were higher than those before operation,while the levels of CD8+,myelin basic protein,high-sensitivity C-reactive protein,intracranial pressure and NIHSS scores were lower than those before operation,and the improvement in the observation group was more obvious(P<0.05 or P<0.01).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).At 6 months after follow-up,the survival rate was lower while the good recovery rate was significantly higher in the observation group than in the control group(P<0.05).Conclusion Standard large craniotomy can improve the immune function and inflammatory state of patients with SCCI,which is of great significance to reduce the level of intracranial pressure and improve the prognosis.