分析重型脑外伤应用改良外伤大骨瓣手术治疗的效果

Analysis of the effect of modified traumatic large bone flap surgery on severe brain injury

目的研究重型脑外伤应用改良外伤大骨瓣手术治疗的效果。方法30例重型脑外伤患者,随机分为对照组和观察组,每组15例。对照组采用标准外伤大骨瓣手术,观察组采用改良外伤大骨瓣手术。比较两组患者手术前后血清炎性因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、颅内压水平、格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分以及术后的并发症发生情况、格拉斯哥预后评分(GOS)、预后情况。结果术后,两组hs-CRP、IL-6、TNF-α水平均低于术前,且观察组患者hs-CRP(6.59±1.35)mg/L、IL-6(8.04±1.20)ng/L、TNF-α(12.20±1.82)ng/L均低于对照组的(11.84±2.01)mg/L、(14.36±2.16)ng/L、(19.53±3.27)ng/L,差异均具有统计学意义(P<0.05)。观察组患者术后1、3、7、14 d的颅内压分别为(23.13±1.67)、(20.11±1.19)、(15.34±1.02)、(10.12±0.84)mm Hg(1 mm Hg=0.133 kPa),均低于对照组的(28.23±2.09)、(23.05±1.63)、(20.04±1.35)、(15.22±1.20)mm Hg,差异均具有统计学意义(P<0.05)。术后,两组患者GCS评分均高于术前,NIHSS评分均低于术前,且观察组患者GCS评分(14.30±0.42)分高于对照组的(11.27±1.89)分,NIHSS评分(7.65±1.15)分低于对照组的(12.10±2.01)分,差异均具有统计学意义(P<0.05)。观察组并发症发生率6.67%低于对照组的40.00%,差异具有统计学意义(P<0.05)。观察组患者术后GOS评分(3.40±0.67)分高于对照组的(2.73±0.45)分,总预后良好率60.00%高于对照组的20.00%,差异均具有统计学意义(P<0.05)。结论改良外伤大骨瓣手术取得的效果确切,主要体现为重型脑外伤患者炎症反应更轻、颅内压控制效果更好、并发症更少、意识障碍程度更轻、神经功能恢复更好且预后效果更优等方面。

Objective To study the effect of modified traumatic large bone flap surgery on severe brain injury.Methods A total of 30 patients with severe brain injury were randomly divided into control group and observation group,with 15 cases in each group.The control group received standard traumatic large bone flap surgery,and the observation group received modified traumatic large bone flap surgery.Both groups were compared in terms of levels of serum inflammatory factors[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],intracranial pressure,Glasgow coma scale(GCS)score,National Institutes of Health Stroke Scale(NIHSS)score before and after surgery,complications,Glasgow outcome scale(GOS)score,and prognosis.Results After surgery,the levels of hs-CRP,IL-6 and TNF-αin both groups were lower than those before surgery in this group;the observation group had hs-CRP of(6.59±1.35)mg/L,IL-6 of(8.04±1.20)ng/L and TNF-αof(12.20±1.82)ng/L,which were lower than those of(11.84±2.01)mg/L,(14.36±2.16)ng/L and(19.53±3.27)ng/L in the control group;the differences were statistically significant(P<0.05).At 1,3,7 and 14 d after surgery,the intracranial pressure in the observation group were(23.13±1.67),(20.11±1.19),(15.34±1.02)and(10.12±0.84)mm Hg(1 mm Hg=0.133 kPa),which were lower than those of(28.23±2.09),(23.05±1.63),(20.04±1.35)and(15.22±1.20)mm Hg in the control group,and the differences were statistically significant(P<0.05).After surgery,GCS score in both groups was higher than that before surgery in this group,and NIHSS score was lower than that before surgery in this group;GCS score of(14.30±0.42)points in the observation group was higher than that of(11.27±1.89)points in the control group,and NIHSS score of(7.65±1.15)points was lower than that of(12.10±2.01)points in the control group;the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 6.67%,which was lower than that of 40.00%in the control group,and the difference was statistically significant(P<0.05).After surgery,GOS score of(3.40±0.67)points in the observation group was higher than that of(2.73±0.45)points in the control group,and the overall good prognosis rate of 60.00%was higher than that of 20.00%in the control group.The differences were statistically significant(P<0.05).Conclusion The results of modified traumatic large bone flap surgery are accurate,mainly in terms of less inflammatory response,better control of intracranial pressure,fewer complications,less impairment of consciousness,better recovery of neurological function and better prognosis in patients with severe traumatic brain injury.