改良去大骨瓣减压术联合高压氧辅助治疗重型颅脑损伤的临床价值

Clinical Value of Modified Decompressed Craniectomy Combined with Hyperbaric Oxygen Adjuvant Therapy in the Patients with of Severe Craniocerebral Injury

目的:探讨重型颅脑损伤(STBI)患者行改良去大骨瓣减压术联合高压氧辅助治疗的临床价值。方法:选取2017年1月—2021年6月淮安市第二人民医院脑外科收治的96例STBI患者作为研究对象,按随机数表法分为对照组(改良去大骨瓣减压术治疗)、观察组(改良去大骨瓣减压术+高压氧辅助治疗),各48例。对比两组格拉斯哥昏迷评分(GCS)、脑血流动力学水平、血清炎症因子及生活质量评分。结果:术后1周,两组GCS评分均高于术前,且观察组GCS评分高于对照组,差异有统计学意义(P<0.05)。术后1个月,两组脑血容量(CBV)、达峰时间(TTP)、脑血流量(CBF)、平均通过时间(MTT)水平均优于术前,且观察组CBV、CBF水平高于对照组,而MTT、TTP水平低于对照组,差异有统计学意义(P<0.05)。术后5 d,观察组血清白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)水平低于术前,而白细胞介素-4(IL-4)水平高于术前,差异有统计学意义(P<0.05);而对照组的血清IL-4、TNF-α、PCT水平与术前比较,差异无统计学意义(P>0.05),但血清IL-2水平低于术前,差异有统计学意义(P<0.05)。术后3个月,两组健康状况、社会功能、躯体疼痛、精神状态、情感职能、精力、生理机能、生理职能评分均较术前升高;且观察组上述各项评分明显高于对照组,差异有统计学意义(P<0.05)。结论:采用改良去大骨瓣减压术联合高压氧辅助治疗STBI患者临床效果显著,可有效改善脑血流动力学及血清炎症因子水平,提高生活质量。

Objective:To investigate the clinical value of modified decompressed craniectomy combined with hyperbaric oxygen therapy in patients with severe traumatic brain injury(STBI).Method:A total of 96 patients with STBI who were admitted to the Brain Surgery Department of Huai’an Second People’s Hospital from January 2017 to June 2021 were selected as the research objects.They were randomly divided into the control group(modified decompressed craniectomy)and the observation group(modified decompressed craniectomy+hyperbaric oxygen adjuvant therapy),48 cases in each group.The changes of Glasgow coma score(GCS),cerebral hemodynamic indexes,serum inflammatory factors and quality of life were compared between the two groups.Result:One week after the operation,the GCS scores of the two groups were higher than those before the operation,and the GCS score of the observation group was higher than that of the control group,the differences were statistically significant(P<0.05).One month after operation,the levels of cerebral blood volume(CBV),time to peak(TTP),cerebral blood flow(CBF)and mean transit time(MTT)in the two groups were better than those before operation,and the levels of CBV and CBF in the observation group were higher than those in the control group,while the levels of MTT and TTP were lower than those in the control group,the differences were statistically significant(P<0.05).At 5 days after operation,the serum levels of interleukin-2(IL-2),tumor necrosis factor-α(TNF-α)and procalcitonin(PCT)in observation group were lower than those before operation,but the serum levels of interleukin-4(IL-4)were higher than those before operation,the differences were statistically significant(P<0.05).While the serum levels of IL-4,TNF-αand PCT in the control group were not significantly different from those before operation(P>0.05),but the serum level of IL-2 was significantly lower than that before operation,the difference was statistically significant(P<0.05).Three months after operation,the scores of health status,social function,body pain,mental state,emotional function,energy,physiological function and physiological function in both groups were higher than those before operation,and above scores in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Adopting modified decompressed craniectomy combined with hyperbaric oxygen adjuvant therapy has significant clinical effects on STBI patients,which can effectively improve cerebral hemodynamics and serum inflammatory factor levels,and improve quality of life.