标准大骨瓣减压后关闭硬脑膜对重型颅脑损伤患者血清S100βNSE水平及术后并发症发生率的影响

Effect of Closing the Dura Mater after Standard Large Bone Flap Decompression on Serum S100βand NSE Levels and the Incidence of Postoperative Complications in Patients with Severe Head Injury

目的:探讨标准大骨瓣减压后关闭硬脑膜对重型颅脑损伤(SHI)患者血清S100β、神经元特异性烯醇化酶(NSE)水平及术后并发症发生率的影响。方法:选取2019年2月至2020年6月我院SHI患者80例,依据治疗方案不同分为研究组(n=41)、对照组(n=39)。研究组在标准大骨瓣减压后关闭硬脑膜,对照组不关闭硬脑膜。比较两组手术有关指标、并发症、术前、术后3d、7d血清S100β、NSE水平、术前、术后2周、1个月神经功能评分(NIHSS)、昏迷程度评分(GCS)、术前、术后3个月、6个月认知功能评分(MMSE)、日常生活能力评分(BI)、生活质量评分(GQOLI-74),并统计术后6个月预后情况。结果:研究组ICU住院时间短于对照组(P<0.05);研究组术后3d、7d血清S100β、NSE水平均低于对照组(P<0.05);研究组术后2周、1个月NIHSS评分均低于对照组,GCS评分高于对照组(P<0.05);研究组术后3个月、6个月MMSE、BI、GQOLI-74评分均高于对照组(P<0.05);研究组术后并发症发生率12.20%较对照组30.77%低(P<0.05);研究组术后6个月预后情况优于对照组(P<0.05)。结论:SHI患者标准大骨瓣减压后关闭硬脑膜,可降低血清S100β、NSE水平,减少并发症,改善认知功能及日常活动能力,提高生活质量,有重要脑保护作用。

Objective:To investigate the effect of closing the dura mater after standard large bone flap decompression on serum S100β,neuron specific enolase(NSE)levels and the incidence of postoperative complications in patients with severe head injury(SHI).Methods:A total of 80 SHI patients in our hospital from February 2019 to June 2020 were selected and divided into study group(n=41)and control group(n=39)according to different treatment plans.In study group,the dura mater was closed after standard large bone flap decompression,while in control group,it was not closed.The related indexes,complications,serum S100βand NSE levels before operation,3 d and 7 d after operation were compared,as well as the neurological function score(NIHSS)and glasgow coma scaley score(GCS)before operation,2 weeks and 1 month after operation,the cognitive function score(MMSE),ability of daily living score(BI),and quality of life score(GQOLI-74)before operation,3 months and 6 months after operation between the two groups.The prognosis of 6 months after operation was calculated.Results:The length of stay in ICU of study group was shorter than that of control group(P<0.05).The serum S100βand NSE levels of study group were lower than those of control group at 3 and 7 days after operation(P<0.05).The NIHSS score of study group was lower than that of control group at 2 weeks and 1 month after operation,and the GCS score of study group was higher than that of control group(P<0.05).The scores of MMSE,BI and GQOLI-74 in study group were higher than those in control group at 3 months and 6 months after operation(P<0.05).The postoperative complication rate of study group was 12.20%lower than that of 30.77%in control group(P<0.05).The prognosis of study group was better than that of control group at 6 months(P<0.05).Conclusion:Closing the dura mater after decompressing the standard large bone flap in SHI patients can reduce serum S100βand NSE levels,reduce complications,improve cognitive function and daily activities,improve quality of life,and have important brain protection effects.