亚低温联合去骨瓣减压术对重度颅脑损伤患者神经功能等的影响

The effects of hypothermia combined with decompressive craniectomy on neurological function and inflammatory cytokine levels in patients with severe traumatic brain injury

目的探讨重度颅脑损伤(SHI)患者经亚低温治疗联合去骨瓣减压术(DC)治疗后神经功能及炎性因子水平改善情况。方法采用随机数字表法将56例SHI患者分为A组、B组,每组例数均为28例。A组给予DC,B组在A组基础上给予亚低温治疗。两组均随访2个月。比较两组术后1 d及术后7 d的炎性因子、神经功能,随访2个月后的预后情况,随访期间的术后并发症。结果与术后1 d比较,术后7 d,两组炎性因子、血清碱性磷酸酶(ALP)、神经元特异性烯醇化酶(NSE)水平及神经功能缺损评分(NIHSS)均降低,且相比于A组,B组更低(P<0.05)。随访2个月后,B组预后良好率高于A组(P<0.05)。随访期间,B组癫痫、脑积水发生率均低于A组(P<0.05)。结论亚低温治疗联合DC可减轻SHI患者炎症反应,促进患者神经功能的改善,并促进术后并发症发生率降低,进而有效提高患者预后。

Objective To explore the improvement of neurological function and levels of inflammatory cytokine in patients with severe traumatic brain injury(SHI)treated with hypothermia combined with decompressive craniectomy(DC).Methods 56 patients with SHI were divided into the group A and the group B using a random number table method,with 28 cases in each group.The grouping method was random number table method.The patients in the group A received DC,while in the group B received DC and mild hypothermia treatment.Both groups were followed up for 2 months.The inflammatory factors,neurological function 1 and 7 d after surgery,prognosis after 2 months of follow-up,and postoperative complications during follow-up between the two groups were compared.Results Compared with 1 d after surgery,7 d after surgery,the levels of inflammatory factors serum alkaline phosphatase(ALP)and neuron specific enolase(NSE)and nerve function deficit score(NIHSS)of 2 groups were decreased,and compared with the group A,the group B was lower(P<0.05).After 2 months of follow-up,the rate of good prognosis in the group B was higher than that in the group A(P<0.05).During the follow-up period,the incidence of epilepsy and hydrocephalus in the group B were lower than those in the group A(P<0.05).Conclusion Mild hypothermia combined with DC could reduce the inflammatory response of patients with SHI,promote the improvement of their neurological function,and reduce the incidence of postoperative complications,thereby effectively improving the prognosis of patients,