着力部位硬膜外血肿清除术联合去骨瓣减压术治疗重型对冲性颅脑损伤患者的效果

Efficacy of Epidural Hematoma Evacuation at the Focus Site Combined with Decompressive Craniectomy in the Treatment of Contre-Coup Biain Injury

目的探讨着力部位硬膜外血肿(EH)清除术联合去骨瓣减压术(DC)治疗重型对冲性颅脑损伤(CCBI)患者的效果及对miRNAs水平的影响。方法选取2017年1月至2020年7月在鲁山县人民医院就诊的90例CCBI患者,根据就诊序号采用电脑随机数字表法分为研究组(n=45)和常规组(n=45)。常规组接受单侧颞额部血肿清除术联合DC治疗,研究组接受着力部位EH清除术联合DC治疗。对比两组总有效率;对比术前及术后1、3、7、10d颅内压水平、中线移位幅度、对侧血肿厚度(HT)、格拉斯哥昏迷量表(GCS)评分;对比术前及术后3d血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)水平;对比术前及术后7、14d血清miR-93、miR-199、miR-499水平。结果研究组总有效率较常规组高(P<0.05);两组术后1、3、7、10d颅内压水平较治疗前低(P<0.05),但组间对比,差异无统计学意义(P>0.05);研究组术后对侧HT及中线移位幅度较常规组优(P<0.05);术后1、3、7、10d两组GCS评分较治疗前高,研究组较常规组高(P<0.05);两组术后3d血清SOD、GSH-Px水平均较术前升高,血清MDA水平均较术前降低,研究组血清SOD、GSH-Px水平较常规组高,血清MDA水平较常规组低(P<0.05);术后7、14d两组血清miR-93、miR-199、miR-499水平较术前低,研究组较常规组低(P<0.05)。结论着力部位EH清除术联合DC治疗CCBI患者效果显著,可有效改善意识状态,调节颅内压水平,降低中线移位幅度及对侧HT,缓解氧化应激状态,优化预后效果,值得临床推广。

Objective To investigate the efficacy of epidural hematoma(EH)evacuation at the focus site combined with decompressive craniectomy(DC)in the treatment of patients with contre-coup brain injury(CCBI)and its effect on the levels of miRNAs.Methods A total of 90 patients with CCBI who visited Lushan County People’s Hospital from January 2017 to July 2020 were selected and divided into observation group(n=45)and control group(n=45)by computer random number table method according to the number of visits.The control group was treated with unilateral temporofrontal hematoma evacuation combined with DC,and the observation group was treated with EH evacuation at the focus site combined with DC.The total effective rate was compared between the two groups.The intracranial pressure levels,midline shift range,contralateral hematoma thickness(HT),and Glasgow coma scale(GCS)scores were compared before and 1,3,7 and 10 days after operation.The levels of serum superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and malondialdehyde(MDA)were compared before and 3 days after operation.The levels of serum miR-93,miR-199,miR-499 before and 7 and 14 days after operation were compared.Results The total effective rate in the observation group was higher than that in the control group(P<0.05).The intracranial pressure levels of the two groups on 1,3,7 and 10 days after operation were lower than those before treatment(P<0.05),but there was no statistical difference between the two groups(P>0.05).The postoperative contralateral HT and midline shift in the observation group were better than those in the control group(P<0.05).On the 1,3,7 and 10 days after operation,the GCS scores of the two groups were higher than those before treatment,and the observation group was higher than the control group(P<0.05).On the 3 days after the operation,the levels of serum SOD and GSH-Px in the two groups were higher than those before operation,and the levels of serum MDA were lower than those before operation and the levels of SOD and GSH-Px in the observation group were higher than those of the control group,and the level of MDA was lower than that of the control group(P<0.05).The serum levels of miR-93,miR-199 and miR-499 in the two groups were lower than those before the operation on the 7 and 14 days after the operation,and the observation group was lower than the control group(P<0.05).Conclusion EH evacuation at the focus site combined with DC in the treatment of CCBI patients has a significant effect,can effectively improve the state of consciousness,regulate the level of intracranial pressure,reduce the midline shift range and contralateral HT,and optimize the prognosis,which is worthy of clinical promotion.