大骨瓣渐进与常规减压术救治重症颅脑损伤效果评价

Efficacy of large bone flap progressive decompression versus conventional decompression in treatment of severe craniocerebral injury

目的探讨大骨瓣渐进减压术救治重症颅脑损伤病人的效果及其对相关神经因子和炎症因子影响。方法选择2019年1月—2022年12月南通市第三人民医院救治的重症颅脑损伤病人120例为研究对象,随机分为两组,每组60例。研究组实施渐进性骨瓣减压术,对照组进行常规骨瓣减压术。比较两组病人的治疗效果、美国国立卫生研究院卒中量表(NIHSS)和格拉斯哥昏迷评分法(GCS)评分以及神经功能等指标的差异。结果研究组术后的脑中线位移和不同时间颅内压均显著低于对照组(t=27.706,F=12.135~29.915,P均<0.001);研究组NIHSS评分显著低于对照组,而GCS评分显著高于对照组(t=3.388~7.844,P<0.001)。研究组术后血清肾素、肾上腺素、血管紧张素Ⅱ和去甲肾上腺素等应激反应因子均显著高于对照组(t=4.147~70.340,P<0.001),相关炎症、循环和神经因子均显著低于对照组(t=5.127~9.763,P<0.001)。术后研究组认知功能、躯体功能、社会功能、情绪功能和总评分均显著高于对照组(t=8.226~31.690,P<0.001)。结论采取大骨瓣渐进减压术救治重症颅脑损伤病人临床效果更好,术后炎症和应激反应以及循环与神经功能恢复效果更显著,病人生活质量更高。

Objective To investigate the efficacy of large bone flap progressive decompression in the treatment of severe craniocerebral injury and its effect on neurocytokines and inflammatory factors.Methods A total of 120 patients with severe craniocerebral injury who were treated in Nantong Third People’s Hospital from January 2019 to December 2022 were enrolled as subjects,and they were randomly divided into study group and control group,with 60 patients in each group.The patients in the study group received progressive decompression,and those in the control group received conventional decompression.The two groups were compared in terms of treatment outcome,NIH Stroke Scale score,Glasgow Coma Scale(GCS)score,and neurological function.Results Compared with the control group,the study group had significantly lower midline displacement and intracranial pressure at different time points(t=27.706,F=12.135-29.915,P<0.001),as well as a significantly lower NIHSS score and a significantly higher GCS score(t=3.388-7.844,P<0.001).After surgery,compared with the control group,the stu-dy group had significantly higher levels of stress response factors such as serum renin,epinephrine,angiotensinⅡ,and norepinephrine(t=4.147-70.340,P<0.001)and significantly lower levels of related inflammatory,circulatory,and neurological factors(t=5.127-9.763,P<0.001).After surgery,the study group had significantly higher total score and scores of cognitive function,physical function,social function,and emotional function than the control group(t=8.226-31.690,P<0.001).Conclusion Large bone flap progressive decompression has a better clinical effect in the treatment of patients with severe craniocerebral injury,with significant recovery of inflammatory and stress response and circulatory and neurological functions and better quality of life.