标准去大骨瓣与控制性减压术治疗重型颅脑损伤的效果对比

Comparison of the effect of standard decompressive craniectomy and controlled decompression in the treatment of severe craniocerebral injury

目的探讨标准去大骨瓣与控制性减压术治疗重型颅脑损伤的临床效果。方法80例重型颅脑损伤并接受手术治疗的患者为研究对象,按照随机数字表法分为对照组与观察组,各40例。对照组采取标准去大骨瓣减压术治疗,观察组应用控制性减压术治疗。比较两组术后48 h神经损伤相关因子水平,手术前后格拉斯哥昏迷评分,术后并发症发生情况及脑灌注压。结果观察组术后48 h神经元特异性烯醇化酶和S-100B蛋白水平分别为(5.8±0.5)ng/ml和(0.7±0.1)μg/L,均显著低于对照组的(15.9±1.8)ng/ml、(1.9±0.3)μg/L(P<0.05)。术后7 d,两组格拉斯哥昏迷评分均高于术前,且观察组格拉斯哥昏迷评分(10.7±2.2)分显著高于对照组的(7.9±1.5)分(P<0.05)。观察组术后并发症发生率5.0%显著低于对照组的30.0%(P<0.05)。术后1、3、7 d,观察组脑灌注压分别为(89.7±5.8)、(95.3±6.8)、(99.7±7.3)mm Hg(1 mm Hg=0.133 kPa),均显著高于对照组的(57.9±5.7)、(59.9±6.2)、(63.7±4.9)mm Hg(t=24.732、24.330、25.897,P=0.000、0.000、0.000<0.05)。结论针对重型颅脑损伤患者,采取控制性减压术联合亚低温治疗,具有减少医源性损伤、确保脑灌注压、促进神经功能恢复的作用,且并发症少,安全性高。

Objective To explore the clinical effect of standard decompressive craniectomy and controlled decompression in the treatment of severe craniocerebral injury.Methods 80 patients with severe craniocerebral injury who received surgical treatment were divided into a control group and an observation group according to random number table method,with 40 cases in each group.The control group was treated with standard decompressive craniectomy,and the observation group was treated with controlled decompression.The levels of nerve injury related factors at 48 h postoperatively,Glasgow coma score before and after surgery,postoperative complications and cerebral perfusion pressure were compared between the two groups.Results The levels of neuron-specific enolase and S-100B protein in the observation group were(5.8±0.5)ng/ml and(0.7±0.1)μg/L at 48 h postoperatively,which were significantly lower than(15.9±1.8)ng/ml and(1.9±0.3)μg/L in the control group(P<0.05).At 7 d postoperatively,the Glasgow coma score in both groups was higher than that before surgery,and the Glasgow coma score in the observation group was(10.7±2.2)points,which was significantly higher than(7.9±1.5)points in the control group(P<0.05).The incidence of postoperative complications in the observation group was 5.0%,which was significantly lower than 30.0%in the control group(P<0.05).On postoperative day 1,3 and 7,the cerebral perfusion pressure in the observation group were(89.7±5.8),(95.3±6.8)and(99.7±7.3)mm Hg(1 mm Hg=0.133 kPa),which were significantly higher than(57.9±5.7),(59.9±6.2)and(63.7±4.9)mm Hg in the control group(t=24.732,24.330,25.897;P=0.000,0.000,0.000<0.05).Conclusion For patients with severe craniocerebral injury,controlled decompression combined with mild hypothermia can reduce iatrogenic injury,ensure cerebral perfusion pressure and promote the recovery of neurological function,and it has fewer complications and high safety.