标准大骨瓣减压手术对颅脑损伤患者单核细胞趋化蛋白-1、超敏C反应蛋白水平的影响及其因素分析
|
摘要
目的探讨标准大骨瓣减压手术对颅脑损伤患者单核细胞趋化蛋白-1(MCP-1)、超敏C反应蛋白(hs-CRP)因子水平的影响及其因素。方法南充市中心医院神经外科2015年5月—2018年5月收治颅脑损伤患者110例,按照数字表法将其随机分为两组,分别采用传统大骨瓣减压手术治疗(传统组)和标准大骨瓣减压手术治疗(标准组),各55例。采用酶联免疫吸附法检测患者MCP-1、hs-CRP、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)以及白细胞介素-2(IL-2),采用CT检测患者脑血流动力学,主要指标包含平均通过时间(MTT)、达峰时间(TTP)、脑血流量(CBF)以及脑血容量(CBV),检测患者蛋白代谢以及脑代谢情况,脑代谢包含:混合静脉血氧饱和度(SVO_2)、脑氧摄取率(CEO_2);蛋白代谢包含:转铁蛋白(TRE)、视黄醇结合蛋白(RBP)、前白蛋白(PA)。结果术后1周,标准组MCP-1、hs-CRP、TNF-α、IL-2水平均低于传统组(P<0.05),IL-4水平高于传统组(P<0.05);标准组TIP、MTT低于传统组(P<0.05),CBF、CBV高于传统组(P<0.05);术后4周,标准组TTP、MTT低于传统组(P<0.05),CBF、CBV高于传统组(P<0.05);术后1周,标准组脑代谢(CEO_2、 SVO_2)、蛋白代谢(PA、TRE、RBP)均高于传统组(P<0.05),预后良好率高于传统组(P<0.05),预后不良率低于传统组(P<0.05)。经单因素分析得出,影响患者预后的因素有年龄、损伤至接受手术时间、损伤部位、脑疝以及术后苏醒时间,差异有统计学意义(P<0.05);经多因素Logistic回归分析得出,年龄>50岁、损伤时间>24h、损伤部位为脑干或小脑、发生脑疝以及术后苏醒时间>7d是影响患者预后的独立危险因素,差异有统计学意义(P<0.05)。结论采用标准大骨瓣减压手术治疗对患者机体造成的影响较小,可有效缓解机体炎症反应,改善代谢状态和预后。
Objective To investigate the effect of standard large trauma craniotomy on the levels of MCP-1 and hs-CRP factors in patients with craniocerebral trauma and the its factors. Methods Totally 110 patients with craniocerebral trauma admitted to our hospital from May 2015 to May 2018 were selected and randomly divided into two groups according to the digital table method. The patients in the control group were treated with conventional large trauma craniotomy,while those in the study group were treated with standard large trauma craniotomy. ELISA was used for the detection of interleukin 4(IL-4), interleukin 2(IL-2) in MCP-1, hs-CRP, tumor necrosis factor alpha(TNF). Cerebral hemodynamics was measured by CT,and the main indicators included mean time to passage(MTT),time to peak(TTP),cerebral blood flow(CBF) and cerebral blood volume(CBV). Protein metabolism and brain metabolism of the patients were detected. Brain metabolism included mixed venous blood oxygen saturation(SVO_2) and cerebral oxygen uptake rate(CEO_2).Protein metabolism included transferrin(TRE), retinol-binding protein(RBP) and prealbumin(PA) Results At 7 days after the operation,hs-CRP,MCP-1,TNF-α and IL-2 levels in the study group were lower than those in the control group(P< 0.05),and IL-4 levels in the study group were higher than those in the control group(P<0.05). At 7 days after surgery,TIP and MTT in the study group were lower than those in the control group(P< 0.05),and CBF and CBV in the study group were higher than those in the control group(P< 0.05). Four weeks after surgery,TIP and MTT in the study group were lower than those in the control group(P< 0.05),and CBF and CBV in the study group were higher than those in the control group(P<0.05). Brain metabolism(CEO_2,SVO_2) and protein metabolism(PA,TRE,RBP) in the study group were all higher than those in the control group(P<0.05). The rate of good prognosis in the study group was higher than that in the control group(P<0.05),and the rate of poor prognosis in the study group was lower than that in the control group(P<0.05). After univariate analysis,it was found that the factors influencing the prognosis of the patients were age,the time from injury to surgery,the site of injury,cerebral hernia and postoperative recovery time,with statistically significant differences(P<0.05). Multivariate Logistic regression analysis showed that age over 50 years old,injury time over 24 hours,injury site in brainstem or cerebellum,occurrence of cerebral hernia and postoperative recovery time over 7 days were independent risk factors affecting the prognosis of patients,with statistically significant differences(P<0.05). Conclusion The standard large trauma craniotomy surgery has relatively little effect on the patient's body,which can effectively alleviate the body's inflammatory response,improve the metabolic status and the prognosis of patients.
Objective To investigate the effect of standard large trauma craniotomy on the levels of MCP-1 and hs-CRP factors in patients with craniocerebral trauma and the its factors. Methods Totally 110 patients with craniocerebral trauma admitted to our hospital from May 2015 to May 2018 were selected and randomly divided into two groups according to the digital table method. The patients in the control group were treated with conventional large trauma craniotomy,while those in the study group were treated with standard large trauma craniotomy. ELISA was used for the detection of interleukin 4(IL-4), interleukin 2(IL-2) in MCP-1, hs-CRP, tumor necrosis factor alpha(TNF). Cerebral hemodynamics was measured by CT,and the main indicators included mean time to passage(MTT),time to peak(TTP),cerebral blood flow(CBF) and cerebral blood volume(CBV). Protein metabolism and brain metabolism of the patients were detected. Brain metabolism included mixed venous blood oxygen saturation(SVO_2) and cerebral oxygen uptake rate(CEO_2).Protein metabolism included transferrin(TRE), retinol-binding protein(RBP) and prealbumin(PA) Results At 7 days after the operation,hs-CRP,MCP-1,TNF-α and IL-2 levels in the study group were lower than those in the control group(P< 0.05),and IL-4 levels in the study group were higher than those in the control group(P<0.05). At 7 days after surgery,TIP and MTT in the study group were lower than those in the control group(P< 0.05),and CBF and CBV in the study group were higher than those in the control group(P< 0.05). Four weeks after surgery,TIP and MTT in the study group were lower than those in the control group(P< 0.05),and CBF and CBV in the study group were higher than those in the control group(P<0.05). Brain metabolism(CEO_2,SVO_2) and protein metabolism(PA,TRE,RBP) in the study group were all higher than those in the control group(P<0.05). The rate of good prognosis in the study group was higher than that in the control group(P<0.05),and the rate of poor prognosis in the study group was lower than that in the control group(P<0.05). After univariate analysis,it was found that the factors influencing the prognosis of the patients were age,the time from injury to surgery,the site of injury,cerebral hernia and postoperative recovery time,with statistically significant differences(P<0.05). Multivariate Logistic regression analysis showed that age over 50 years old,injury time over 24 hours,injury site in brainstem or cerebellum,occurrence of cerebral hernia and postoperative recovery time over 7 days were independent risk factors affecting the prognosis of patients,with statistically significant differences(P<0.05). Conclusion The standard large trauma craniotomy surgery has relatively little effect on the patient's body,which can effectively alleviate the body's inflammatory response,improve the metabolic status and the prognosis of patients.
引文
[1] 陈小波,余小祥,肖庆保.醒脑静注射液联合改良去大骨瓣减压术对重型颅脑损伤患者术后颅内压及血清炎症因子水平的影响[J].中国药房,2018,14(5):674-678.
[2] 朱振云,梁建锋,张红彬,等.重型脑创伤大骨瓣减压术后脑膨出影响因素分析[J].山东医药,2016,56(26):95-96.
[3] Sauvigny T,G?ttsche J,Czorlich P,et al.Intracranial pressure in patients undergoing decompressive craniectomy:new perspective on thresholds[J].J Neurosurg,2017,128(3):1-9.
[4] 张博,杨明飞.鹿特丹CT评分评估行去骨瓣减压术颅脑损伤患者的预后[J].实用医学杂志,2018,23(8):1368-1371.
[5] 吴颖,刘淑红,刘亚晶,等.氨溴索辅助支气管肺泡灌洗术对颅脑损伤患者行气管切开后相关指标的影响[J].中国药房,2016,27(33):4644-4646.
[6] Picetti E,Caspani M L,Iaccarino C,et al.Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury:a clinical study[J].Acta Neurochir (Wien),2017,159(4):1-8.
[7] 刘爱生,姚焱鹏.标准取大骨瓣减压术与扩大取骨瓣减压术的显露程度及其损伤程度的解剖学评价[J].解剖学杂志,2017,40(1):52-55.
[8] 甘宁,刘思思,李英姿,等.重型颅脑损伤患者改良大骨瓣减压术中渐进减压与常规减压对比观察[J].山东医药,2017,57(27):70-72.
[9] Takeuchi H,Higashino Y,Hosoda T,et al.Long-term follow-up of cryopreservation with glycerol of autologous bone flaps for cranioplasty after decompressive craniectomy[J].Acta Neurochir (Wien),2016,158(3):571-575.
[10] 柏鲁宁,柯尊华,畅涛,等.大骨瓣减压术后并发硬膜下积液患者的预后分析[J].中华神经医学杂志,2016,15(11):1167-1169.
[11] 侯小山,金鹏,魏文峰,等.颅脑损伤去骨瓣减压术后继发硬膜下积液的危险因素分析[J].国际神经病学神经外科学杂志,2017,44(5):468-471.
[12] Manfiotto M,Mottolese C,Szathmari A,et al.Decompressive craniectomy and CSF disorders in children[J].Childs Nerv Syst,2017,33(10):1751-1757.
[13] 周洲,钱尧.去骨瓣减压术在重型颅脑损伤中的应用及疗效研究进展[J].国际神经病学神经外科学杂志,2017,44(5):543-546.
[14] Wettervik TS,Lenell S,Nyholm L,et al.Decompressive craniectomy in traumatic brain injury:usage and clinical outcome in a single centre:[J].Acta Neurochir,2018,160(2):229-237.
[15] 陈飞宇,陈光烈,任浩君,等.颅脑损伤患者开颅术后颅内感染的相关因素与耐药性分析[J].中华医院感染学杂志,2016,23(4):799-801.
[2] 朱振云,梁建锋,张红彬,等.重型脑创伤大骨瓣减压术后脑膨出影响因素分析[J].山东医药,2016,56(26):95-96.
[3] Sauvigny T,G?ttsche J,Czorlich P,et al.Intracranial pressure in patients undergoing decompressive craniectomy:new perspective on thresholds[J].J Neurosurg,2017,128(3):1-9.
[4] 张博,杨明飞.鹿特丹CT评分评估行去骨瓣减压术颅脑损伤患者的预后[J].实用医学杂志,2018,23(8):1368-1371.
[5] 吴颖,刘淑红,刘亚晶,等.氨溴索辅助支气管肺泡灌洗术对颅脑损伤患者行气管切开后相关指标的影响[J].中国药房,2016,27(33):4644-4646.
[6] Picetti E,Caspani M L,Iaccarino C,et al.Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury:a clinical study[J].Acta Neurochir (Wien),2017,159(4):1-8.
[7] 刘爱生,姚焱鹏.标准取大骨瓣减压术与扩大取骨瓣减压术的显露程度及其损伤程度的解剖学评价[J].解剖学杂志,2017,40(1):52-55.
[8] 甘宁,刘思思,李英姿,等.重型颅脑损伤患者改良大骨瓣减压术中渐进减压与常规减压对比观察[J].山东医药,2017,57(27):70-72.
[9] Takeuchi H,Higashino Y,Hosoda T,et al.Long-term follow-up of cryopreservation with glycerol of autologous bone flaps for cranioplasty after decompressive craniectomy[J].Acta Neurochir (Wien),2016,158(3):571-575.
[10] 柏鲁宁,柯尊华,畅涛,等.大骨瓣减压术后并发硬膜下积液患者的预后分析[J].中华神经医学杂志,2016,15(11):1167-1169.
[11] 侯小山,金鹏,魏文峰,等.颅脑损伤去骨瓣减压术后继发硬膜下积液的危险因素分析[J].国际神经病学神经外科学杂志,2017,44(5):468-471.
[12] Manfiotto M,Mottolese C,Szathmari A,et al.Decompressive craniectomy and CSF disorders in children[J].Childs Nerv Syst,2017,33(10):1751-1757.
[13] 周洲,钱尧.去骨瓣减压术在重型颅脑损伤中的应用及疗效研究进展[J].国际神经病学神经外科学杂志,2017,44(5):543-546.
[14] Wettervik TS,Lenell S,Nyholm L,et al.Decompressive craniectomy in traumatic brain injury:usage and clinical outcome in a single centre:[J].Acta Neurochir,2018,160(2):229-237.
[15] 陈飞宇,陈光烈,任浩君,等.颅脑损伤患者开颅术后颅内感染的相关因素与耐药性分析[J].中华医院感染学杂志,2016,23(4):799-801.