改良去骨瓣减压术治疗重型创伤性脑损伤疗效观察

Therapeutic effect of modified decompressive craniectomy in the treatment of severe traumatic brain injury

目的观察改良去骨瓣减压术治疗重型创伤性脑损伤(sTBI)的疗效,为临床治疗提供指导。方法选取2019年6月至2022年6月榆林市星元医院收治的80例sTBI患者进行前瞻性研究,按随机数表法分为观察组和对照组各40例。对照组患者采用常规去骨瓣减压术治疗,观察组患者采用改良去骨瓣减压术治疗。比较两组患者术前及术后1 d、3 d、5 d的颅内压、术前及术后7d的白细胞介素-6(IL-6)、白细胞介素-18(IL-18)、高敏C反应蛋白(hs-CRP)水平和认知功能、日常生活能力以及术后1个月的预后情况。结果观察组患者术后1 d、3 d、5 d的颅内压分别为(20.23±0.96)mmHg、(17.52±1.53)mmHg、(13.44±1.19)mmHg,明显低于对照组的(23.06±1.86)mmHg、(21.19±1.35)mmHg、(17.16±1.41)mmHg,差异均有统计学意义(P<0.05);观察组患者术后7 d的IL-6、IL-18及hs-CRP水平分别为(14.68±2.22)mg/L、(35.62±6.10)mg/L、(6.64±1.25)mg/L,明显低于对照组的(18.85±3.61)mg/L、(42.34±4.55)mg/L、(10.09±2.05)mg/L,差异均有统计学意义(P<0.05);观察组患者术后7 d瞬时记忆、短时记忆、语言能力、定向力、视觉空间、注意力计算力等认知功能评分明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后7 d的进食、洗澡、穿衣、修饰、小便控制、大便控制、如厕、平地行走、床椅转移、上下楼梯等日常生活功能评分明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后1个月的预后良好率为67.50%,明显高于对照组的17.50%,差异有统计学意义(P<0.05)。结论改良去骨瓣减压术治疗sTBI不仅能有效控制患者的炎性细胞因子水平,降低患者颅内压,还能有效改善患者认知功能和日常生活能力,临床治疗效果显著且预后较好。

Objective To observe the effect of modified decompressive craniectomy in the treatment of severe traumatic brain injury(sTBI)and provide guidance for clinical treatment.Methods A prospective study was conducted on 80 patients with sTBI admitted to Xingyuan Hospital of Yulin from June 2019 to June 2022.They were divided into an observation group and a control group,each with 40 cases.According to random number table,the control group was given conventional decompressive craniectomy,and the observation group was given modified decompressive craniectomy.The changes of intracranial pressure before and at 1,3,and 5 days after the surgery,the changes of interleukin-6(IL-6),interleukin-18(IL-18),high-sensitivity C-reactive protein(hs-CRP),cognitive function,and activities of daily living before and at 7 days after surgery,and 1-month postoperative prognosis were observed and compared between the two groups.Results The intracranial pressures in the observation group were(20.23±0.96)mmHg,(17.52±1.53)mmHg,and(13.44±1.19)mmHg at 1 d,3 d,and 5 d after surgery,which were significantly lower than(23.06±1.86)mmHg,(21.19±1.35)mmHg,and(17.16±1.41)mmHg in the control group(P<0.05).The levels of cytokines such as IL-6,IL-18,and hs-CRP in the observation group were(14.68±2.22)mg/L,(35.62±6.10)mg/L,and(6.64±1.25)mg/L at 7 days after operation,which were significantly lower than(18.85±3.61)mg/L,(42.34±4.55)mg/L,and(10.09±2.05)mg/L in the control group(P<0.05).The cognitive function scores such as instantaneous memory,short-term memory,language ability,orientation ability,visuospatial ability,and attention calculation ability in the observation group after operation were significantly higher than those of the control group(P<0.05).The scores of daily life functions such as eating,bathing,dressing,grooming,urination control,stool control,going to the toilet,walking on level ground,bed and chair transfer,and going up and down stairs in the observation group after operation were significantly higher than those of the control group(P<0.05).The good rate of 1-month postoperative prognosis in the observation group was 67.50%,which was significantly higher than 17.50%in the control group(P<0.05).Conclusion Modified decompressive craniectomy for sTBI can not only effectively control the level of inflammatory cytokines and reduce the intracranial pressure of patients,but also effectively improve the cognitive function and daily living ability of patients,with significant clinical treatment effect and good prognosis.