重型颅脑创伤去骨瓣减压术后4~8周与12周修复颅骨改善转归作用比较

Comparison of the improved outcomes of skull repair at 4 to 8 weeks and 12 weeks after craniotomy for severe craniocerebral trauma

目的比较重型颅脑创伤去骨瓣减压术后4~8 w与12 w修复颅骨对预后转归的改善作用。方法选取2022年1月至2023年1月三二〇一医院收治的重型颅脑创伤102例患者,分为对照组、观察组,每组51例,两组均行去骨瓣减压治疗,观察组于去骨瓣减压后4~8w修复颅骨,对照组于去骨瓣减压后12w行颅骨修复。于颅骨修复术前、术后3d、术后1w比较两组脑氧代谢[颈内静脉血氧含量(CjvO_(2))、血氧饱和度(SjvO_(2))、脑氧摄取率(O_(2)ER)]、缺损侧与缺损对侧大脑中动脉(MCA)血流速、神经元特异性烯醇化酶(NSE)、S100蛋白B(S100B)水平变化,于颅骨修复术前、术后3个月、术后6个月评价患者神经功能、认知功能、生活质量,于颅骨修复后6个月评价患者垂体功能状态及预后转归情况。结果术后3d、1w观察组CjvO_(2)、SjvO_(2)、缺损侧与缺损对侧MCA血流速高于对照组,O_(2)ER、NSE、S100B水平低于对照组(P<0.05)。术后3个月、6个月观察组神经功能评分低于对照组,认知功能、生活质量评分高于对照组(P<0.05)。观察组垂体功能减退发生率低于对照组(P>0.05)。观察组预后优良率高于对照组(P<0.05)。结论重型颅脑创伤去骨瓣减压术后4~8 w修复颅脑更有助于改善脑氧代谢、脑动力学,减少神经功能及认知功能风险,促进患者预后转归。

Objective To compare the improvement of prognosis of skull repair at 4-8 weeks and 12 weeks after craniotomy for severe craniocerebral trauma.Methods A total of 102 patients with severe craniocerebral trauma admitted to our hospital from January 2022 to January 2023 were divided into control group and observation group,with51 cases in each group.Both groups received craniotomy decompres sion treatment.The observation group received craniotomy repair 4-8 weeks after craniotomy decompression,and the control group received craniotomy repair 12weeks after craniotomy decompression.Brain oxygen metabolism[jugular vein oxygen content(CjvO2),blood oxygen saturation(SjvO_(2)),brain oxygen uptake rate(O_(2)ER)],brain dynamics[blood flow velocity of middle cerebral artery(MCA)on both sides of the defect],neuron-specific enolase(NSE)and S100B levels were compared between the two groups before skull repair,3 days after surgery and 1 week after surgery Neurological function,cognitive function and quality of life were evaluated before,3 months and 6 months after skull repair,and pituitary function and prognosis were evaluated at 6 months after skull repair.Results The blood flow velocity of CjvO_(2),SjvO_(2),MCA on the defective side and opposite side of the defect in the observation group were higher than those in the control group at 3 days and 1week after surgery,and the levels of O_(2)ER,NSE and S100B were lower than those in the control group(P<0.05).The neurological function scores of the observation group were lower than those of the control group at 3 and 6 months after operation,and the cognitive function and quality of life scores were higher than those of the control group(P<0.05).The incidence of hypopituitarism in observation group was lower than that in control group(P>0.05).The prognosis of observation group was higher than that of control group(P<0.05).Conclusion It is more helpful to repair the brain 4~8 weeks after craniotomy for severe craniocerebral trauma,improve brain oxygen metabolism,brain dynamics,reduce the risk of neurological function and cognitive function,and promote the prognosis of patients.