控制性减压术对颅脑外伤患者再灌注损伤的影响
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摘要
目的探讨控制性减压术对颅脑外伤患者再灌注损伤的影响。方法选取2014-03至2017-03医院收治的颅脑外伤100例,依据治疗方法分为控压组和标压组,每组50例,标压组给予标准减压术治疗,控压组给予控制性减压术治疗,比较两组白介素-6(IL-6)、缺血修饰蛋白(IMA)、E神经元特异性烯醇化酶(NSE)、治疗疗效、并发症、死亡等情况。结果控压组和标压组术后血清IL-6、IMA、NSE水平明显低于术前,控压组术后血清IL-6、IMA、NSE水平明显低于标压组,差异有统计学意义(P<0.05);控压组治疗有效率(96.0%)明显高于标压组(78.0%),差异有统计学意义(P<0.05);控压组并发症发生率(8.0%)明显低于标压组(30.0%),差异有统计学意义(P<0.05),但两组患者病死率无统计学差异(4.0%vs 8.0%,P>0.05)。结论控制性减压术可有效改善颅脑外伤患者脑氧摄取能力,减少再灌注损伤和并发症,值得推广。
Objective To explore the effect of controlled decompression on reperfusion injury in patients with craniocerebral trauma. Methods One hundred patients with craniocerebral traum treated in our hospital between March 2014 and March 2017 were selected as subjects. According to the therapeutic method,these patients were divided into the pressure control group( 50 cases) and the standard pressure group( 50 cases). The pressure control group was treated with controlled decompression,while the standard pressure group was treated with standard decompression. The levels of interleukin-6( IL-6),ischemia modified protein( IMA),neuron specific enolase( NSE),treatment efficacy,complications and death rate were compared between the two groups. Results After operation,levels of serum IL-6,IMA,and NSE of the two groups were significantly lower,especially in the pressure control group,and the difference was statistically significant( P < 0. 05). The effective rate of treatment of the pressure control group( 96. 0%) was significantly higher than that of the standard pressure group( 78. 0%),and the difference was statistically significant( P < 0. 05). The rate of complications of the pressure control group( 8. 0%) was significantly lower than that of the standard pressure group( 30. 0%),and the difference was statistically significant( P < 0. 05). But the mortality of the two groups was basically the same. Conclusions Controlled decompression can effectively improve cerebral oxygen uptake in patients with craniocerebral trauma,reduce reperfusion injury and complications,so it's worthy of clinical promotion.
Objective To explore the effect of controlled decompression on reperfusion injury in patients with craniocerebral trauma. Methods One hundred patients with craniocerebral traum treated in our hospital between March 2014 and March 2017 were selected as subjects. According to the therapeutic method,these patients were divided into the pressure control group( 50 cases) and the standard pressure group( 50 cases). The pressure control group was treated with controlled decompression,while the standard pressure group was treated with standard decompression. The levels of interleukin-6( IL-6),ischemia modified protein( IMA),neuron specific enolase( NSE),treatment efficacy,complications and death rate were compared between the two groups. Results After operation,levels of serum IL-6,IMA,and NSE of the two groups were significantly lower,especially in the pressure control group,and the difference was statistically significant( P < 0. 05). The effective rate of treatment of the pressure control group( 96. 0%) was significantly higher than that of the standard pressure group( 78. 0%),and the difference was statistically significant( P < 0. 05). The rate of complications of the pressure control group( 8. 0%) was significantly lower than that of the standard pressure group( 30. 0%),and the difference was statistically significant( P < 0. 05). But the mortality of the two groups was basically the same. Conclusions Controlled decompression can effectively improve cerebral oxygen uptake in patients with craniocerebral trauma,reduce reperfusion injury and complications,so it's worthy of clinical promotion.
引文
[1]彭军,杨柏林,余超,等.对冲性硬膜下血肿大骨瓣开颅减压预防急性脑膨出的效果[J].武警医学,2016,27(7):658-660.
[2]Nayebaghayee H,Afsharian T.Correlation between Glasgow Coma Scale and brain computed tomographyscan findings in head trauma patients[J].Asian J Neurosurg,2016,11(1):46-49.
[3]Bor-Seng-Shu E,Figueiredo E G,Fonoff E T,et al.Decom-pressive craniectomy and head injury:brain morphometry,ICP,cerebral hemodynamics,cerebral microvascular reactivity,neuro-chemistry[J].Neurosurg Rev,2013,36(3):361-370.
[4]付涛.标准大骨瓣减压术与阶梯式减压术治疗重型颅脑损伤的有效性和安全性对照[J].中国实用医刊,2017,44(13):49-52.
[5]Walcott B P,Kahle K T,Simard J M.The DECRA trial and decompressive craniectomy in diffuse traumatic brain injury:is decompression really ineffective?[J].World Neurosurg,2013,79(1):80-81.
[6]Shklovsky V M,Zotova L I,Malyukova N G,et al.A fight for life and dignity:a case of massive traumatic brain injury and the paths for treatment and neurorehabilitation[J].Psych J,2016,5(1):48-56.
[7]李健康.标准大骨瓣减压术与常规去骨瓣减压术治疗重型颅脑损伤的效果比较[J].临床医学研究与实践,2017,2(16):86-87.
[8]徐鹏,蓝胜勇,梁有明,等.标准去骨瓣减压术联合脑脊液循环重建治疗重型颅脑损伤的疗效比较[J].中国神经精神疾病杂志,2017,43(7):406-409.
[9]Lee J H,Cui H S,Shin S K,et al.Effect of propofol post-treatment on blood-brain barrier integrity and cerebral edema atter transient cerebral ischemia in rats[J].Neurochem Res,2013,38(11):2276-2286.
[10]程波,吴海.标准大骨瓣减压术治疗重型颅脑损伤的手术效果及对患者预后和并发症的影响[J].中国实用神经疾病杂志,2015,18(10):22-24.
[11]苏斌,张治华.控制性减压术防治老年重型颅脑损伤患者并发脑梗死的疗效分析[J].系统医学,2016,1(3):46-49.
[12]李娜,程晋成,齐一龙,等.急性颅脑损伤患者脑脊液和血清IL-6差异表达及其意义[J].蚌埠医学院学报,2015,40(6):752-753,756.
[13]Yang C,Hong T,Shen J,et al.Ketamine exerts antidepressant effects and reduces IL-1βand IL-6 levels in rat prefrontal cortex and hippocampus[J].Exp Ther Med,2013,5(4):1093-1096.
[14]黄从刚,段发亮,吴京雷,等.血清NSE水平对轻中度颅脑损伤患者继发轻度认知功能障碍的预测价值[J].中华神经医学杂志,2017,16(5):513-518.
[15]刘军,袁辉纯,徐立新.体温控制对重型颅脑损伤血肿清除术后的疗效及血清IMA、MDA的影响[J].中国临床神经外科杂志,2016,21(7):412-415.
[16]靳旭亮.控制性阶梯式颅内减压手术治疗重型颅脑创伤疗效观察[J].中国卫生标准管理,2016,7(5):39-40.
[2]Nayebaghayee H,Afsharian T.Correlation between Glasgow Coma Scale and brain computed tomographyscan findings in head trauma patients[J].Asian J Neurosurg,2016,11(1):46-49.
[3]Bor-Seng-Shu E,Figueiredo E G,Fonoff E T,et al.Decom-pressive craniectomy and head injury:brain morphometry,ICP,cerebral hemodynamics,cerebral microvascular reactivity,neuro-chemistry[J].Neurosurg Rev,2013,36(3):361-370.
[4]付涛.标准大骨瓣减压术与阶梯式减压术治疗重型颅脑损伤的有效性和安全性对照[J].中国实用医刊,2017,44(13):49-52.
[5]Walcott B P,Kahle K T,Simard J M.The DECRA trial and decompressive craniectomy in diffuse traumatic brain injury:is decompression really ineffective?[J].World Neurosurg,2013,79(1):80-81.
[6]Shklovsky V M,Zotova L I,Malyukova N G,et al.A fight for life and dignity:a case of massive traumatic brain injury and the paths for treatment and neurorehabilitation[J].Psych J,2016,5(1):48-56.
[7]李健康.标准大骨瓣减压术与常规去骨瓣减压术治疗重型颅脑损伤的效果比较[J].临床医学研究与实践,2017,2(16):86-87.
[8]徐鹏,蓝胜勇,梁有明,等.标准去骨瓣减压术联合脑脊液循环重建治疗重型颅脑损伤的疗效比较[J].中国神经精神疾病杂志,2017,43(7):406-409.
[9]Lee J H,Cui H S,Shin S K,et al.Effect of propofol post-treatment on blood-brain barrier integrity and cerebral edema atter transient cerebral ischemia in rats[J].Neurochem Res,2013,38(11):2276-2286.
[10]程波,吴海.标准大骨瓣减压术治疗重型颅脑损伤的手术效果及对患者预后和并发症的影响[J].中国实用神经疾病杂志,2015,18(10):22-24.
[11]苏斌,张治华.控制性减压术防治老年重型颅脑损伤患者并发脑梗死的疗效分析[J].系统医学,2016,1(3):46-49.
[12]李娜,程晋成,齐一龙,等.急性颅脑损伤患者脑脊液和血清IL-6差异表达及其意义[J].蚌埠医学院学报,2015,40(6):752-753,756.
[13]Yang C,Hong T,Shen J,et al.Ketamine exerts antidepressant effects and reduces IL-1βand IL-6 levels in rat prefrontal cortex and hippocampus[J].Exp Ther Med,2013,5(4):1093-1096.
[14]黄从刚,段发亮,吴京雷,等.血清NSE水平对轻中度颅脑损伤患者继发轻度认知功能障碍的预测价值[J].中华神经医学杂志,2017,16(5):513-518.
[15]刘军,袁辉纯,徐立新.体温控制对重型颅脑损伤血肿清除术后的疗效及血清IMA、MDA的影响[J].中国临床神经外科杂志,2016,21(7):412-415.
[16]靳旭亮.控制性阶梯式颅内减压手术治疗重型颅脑创伤疗效观察[J].中国卫生标准管理,2016,7(5):39-40.