改良去骨瓣减压术处理创伤性脑损伤的有效性和安全性及对炎性介质水平与预后的影响

Effectiveness and safety of modified decompressive craniectomy for traumatic brain injury and its impact on inflammatory mediators and prognosis

目的评估改良去骨瓣减压术处理创伤性脑损伤的有效性和安全性及对患者血清炎性介质水平与预后的影响。方法选择2020年6月-2022年1月南阳市中心医院神经外科收治的82例创伤性脑损伤患者,根据去骨瓣减压手术方式不同分为标准组与改良组,各41例。标准组给予标准去骨瓣减压术,改良组给予改良去骨瓣减压术。比较两组术中出血量,手术时间,住院时间,术前、术后6 h、术后3 d的血清神经元特异性烯醇化酶(NSE)、S-100钙结合蛋白B(S-100β)、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)水平,术后1个月格拉斯哥预后量表(GOS)评分、并发症发生情况及切口愈合等级。结果与标准组比较,改良组住院时间明显缩短(P<0.05),术中出血量、手术时间差异无统计学意义(P>0.05);改良组术后6 h、术后3 d血清NSE、S-100β和炎性因子CRP、PCT、IL-6水平明显低于标准组(P<0.05)。术后1个月改良组GOS评分预后良好率高于标准组[82.9%(34/41)vs.63.4%(26/41),P<0.05],并发症发生率低于标准组[2.4%(1/41)vs.19.5%(8/41),P<0.05],切口愈合分级优于标准组(P<0.05)。结论改良去骨瓣减压术处理创伤性脑损伤,可减轻脑损伤与手术创伤应激,减少并发症发生,加快患者术后康复进程,提高预后良好率,改善切口愈合分级,有效性与安全性较好。

Objective To evaluate the efficacy and safety of modified decompressive craniectomy in treatment of traumatic brain injury and its impact on the serum levels of inflammatory mediators and prognosis.Methods According to different surgical methods,82 patients with traumatic brain injury admitted to the department of neurosurgery of Nanyang Central Hospital from June 2020 to January 2022 were divided into standard group(n=41)and modified group(n=41).The standard group was given standard decompressive craniectomy,and the modified group was given modified decompressive craniectomy.The intraoperative blood loss,operation time and hospital stay,the levels of neuron-specific enolase(NSE),S-100 calcium binding protein B(S-100β),C-reaction protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)before operation,6 hours after operation,and 3 days after operation,Glasgow Outcome Scale(GOS),incidence of complications,and incision healing grade 1 month after operation were compared between two groups.Results Compared with standard group,the hospital stay was significant shorter in modified group(P<0.05),and intraoperative blood loss and operation time were no significant difference in modified group(P>0.05).At 6 hours and 3 days after operation,the levels of NSE,S-100β,CRP,PCT and IL-6 in modified group were lower than those in standard group(P<0.05).Compared with standard group,the good prognosis rate based of GOS was higher in modified group[82.9%(34/41)vs.63.4%(26/41),P<0.05];the total incidence of complications was lower in modified group[2.4%(1/41)vs.19.5%(26/41),P<0.05];and the grade of incision healing was better in modified group(P<0.05).Conclusions Modified decompressive craniectomy in the treatment of traumatic brain injury could reduce stress of brain injury and surgical trauma,and the incidence of complications,help to speed up the postoperative recovery process,improve the rate of good prognosis and the grade of incision healing.Its efficacy and safety is better than standard decompressive craniectomy.