损伤控制神经外科理念指导下逐步递进策略治疗双额叶脑挫裂伤疗效观察

Observation on the effect of the concept of damage control neurosurgery for the treatment of bilateral frontal lobe contusion and laceration

目的探讨双额颞去骨瓣减压术与损伤控制神经外科(DCNS)理念指导下逐步递进策略治疗双额叶脑挫裂伤的效果。方法选取2016-10—2020-06苏州大学附属张家港医院74例双额叶脑挫裂伤患者为研究对象,随机分为2组各37例。对照组予以双额颞去骨瓣减压术,观察组予以DCNS理念指导下逐步递进策略。对比2组格拉斯哥预后评分(GOS)、治疗前后颅内压、脑组织氧代谢指标[脑血氧饱和度(rSO_(2))、脑氧代谢率(CMRO_(2))]及机体内环境相关指标,如炎性因子[白介素6(IL-6)、前列腺素E2(PGE2)、C反应蛋白(CRP)]、电解质(Na^(+)、K^(+)、Mg^(2+)、Ca^(2+))、血常规[白细胞(WBC)、淋巴细胞(LYM)、单核细胞(MON)]。结果2组治疗后6个月GOS评分相比差异无统计学意义(P>0.05);2组治疗后12 h、1 d颅内压均较治疗前下降,且观察组降幅高于对照组,差异有统计学意义(P<0.05);治疗后1 d、7 d观察组rSO_(2)升幅、CMRO_(2)降幅高于对照组,差异有统计学意义(P<0.05);治疗后1 d、7 d,观察组WBC、LYM、MON、IL-6、PGE2、CRP水平低于对照组,Na^(+)、K^(+)、Mg^(2+)、Ca^(2+)高于对照组,差异均有统计学意义(P<0.05)。结论与双额颞去骨瓣减压术相比,DCNS理念指导下逐步递进策略治疗双额叶脑挫裂伤患者,可维持内环境稳定,有效降低颅内压,改善脑氧代谢。

Objective To investigate the effect of double frontotemporal decompressive craniectomy and gradual and progres⁃sive strategy under the guidance of damage control neurosurgery(DCNS)concept in the treatment of bilateral frontal lobe contusion and laceration.Methods A total of 74 patients with bilateral frontal lobe contusion and laceration in our hospital from October 2016 to June 2020 were selected as the research objects,and were divided into groups,with 37 cases in each group.The control group un⁃derwent double frontotemporal decompressive craniectomy and the observation group underwent a gradual and progressive strategy un⁃der the guidance of the concept of DCNS.The Glasgow outcome score(GOS),intracranial pressure,and brain tissue oxygen metabo⁃lism indexes(regional cerebral oxygen saturation(rSO_(2)),cerebral metabolic rate of oxygen(CMRO_(2)))before and after treatment were statistically compared,as well as internal environment related indicators:inflammatory factors(interleukin 6(IL-6),prostaglan⁃din E2(PGE2),C-reactive protein(CRP)),electrolytes(Na^(+),K^(+),Mg^(2+),Ca^(2+)),blood routine(white blood cells(WBC),lymphocytes(LYM),monocytes(MON))between the two groups.Results There was no significant difference in GOS scores between the two groups at 6 months after treatment(P>0.05).Compared with before treatment,the intracranial pressure of the two groups decreased at 12 hours and 1 day after treatment,and the decrease in the observation group was higher than that in the control group,the differ⁃ence was statistically significant(P<0.05).The increase of rSO_(2)and the decrease of CMRO_(2)in the observation group were higher than those in the control group at 1 day and 7 days after treatment,and the difference was statistically significant(P<0.05).One day and 7 days after treatment,the WBC,LYM,MON,IL-6,PGE2,and CRP levels of the observation group were lower than those of the control group,and Na^(+),K^(+),Mg^(2+)and Ca^(2+)were higher than those of the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with double frontotemporal decompressive craniectomy,the gradual and progressive strategy un⁃der the guidance of DCNS concept to treat patients with bilateral frontal lobe contusion and laceration can maintain a stable internal environment,effectively reduce intracranial pressure,and improve cerebral oxygen metabolism.