颅内压监测下控制性减压与开颅血肿清除术联合治疗在重症脑出血患者中的效果

Effect of Combined Treatment of Controlled Decompression and Craniotomy to Clean Hematoma Under Intracranial Pressure Monitoring in Patients with Severe Cerebral Hemorrhage

目的探讨颅内压(ICP)监测下控制性减压与开颅血肿清除术(CCH)联合治疗重症脑出血(SCH)患者的效果。方法回顾性收集西华第一医院2019年1月至2021年3月收治的90例SCH患者,按治疗方案分成A组(n=45)和B组(n=45)。B组接受CCH治疗,A组接受ICP监测下控制性减压与CCH联合治疗。对比两组患者术后3个月的预后效果。比较两组术前和术后14d血清中枢神经特异蛋白(S100β蛋白)、神经元特异性烯醇化酶(NSE)、可溶性Fas(sFas)、Fas配体(FasL)水平以及术后并发症的发生率(并发症主要包括头皮渗液、术后再出血、颅内感染等)。结果A组患者术后3个月的预后效果优于B组(P<0.05);A组患者术后14d血清NSE、S100β蛋白水平低于B组(P<0.05);A组患者术后14d血清sFas、FasL水平低于B组(P<0.05);A组患者并发症总发生率[4.55%(2/44)]低于B组[20.93%(9/43)](P<0.05)。结论应用ICP监测下控制性减压与CCH联合治疗SCH患者可进一步调节血清NSE、S100β蛋白、sFas、FasL水平,改善患者的神经功能,有效提高患者预后,降低患者术后并发症的发生风险。

Objective To investigate the efficacy of controlled decompression combined with craniotomy to clean hematoma(CCH)under intracranial pressure(ICP)monitoring in severe cerebral hemorrhage(SCH)patients.Methods A total of 90 patients with SCH in Xihua First Hospital from January 2019 to March 2021 were collected retrospectively and divided into group A(n=45)and group B(n=45)according to treatment regimens.Group B received CCH therapy,and group A received controlled decompression combined with CCH therapy under ICP monitoring.The prognosis after 3 months of operation was compared between the two group.The serum levels of CNS-specific protein(S100βprotein),neuron specific enolase(NSE),soluble Fas(sFas),and Fas ligand(FasL)before and after 14 days of operation,complication rate(scalp exudation,postoperative rebleeding,intracranial infection,etc.)after operation were compared between the two group.Results The prognosis of group A was better than that of group B after 3 months of operation(P<0.05).The serum levels of NSE and S100βproteins in group A after 14 days of operation were lower than those of group B(P<0.05).Serum levels of sFas and FasL in group A after 14 days of operation were lower than those of group B(P<0.05).The total incidence of complications in group A[4.55%(2/44)]was lower than that in group B[20.93%(9/43)](P<0.05).Conclusion Controlled decompression combined with CCH under ICP monitoring can further regulate serum NSE,S100βprotein,sFas and FasL levels in patients with SCH,improve the neurological function of patients,effectively improve the prognosis of patients,and reduce the risk of postoperative complications.