高压氧辅助标准大骨瓣开颅术对重型颅脑损伤病人血流动力学及血清CRP的影响
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摘要
目的探讨高压氧辅助标准大骨瓣开颅术对重型颅脑损伤病人血流动力学及血清C反应蛋白的影响。方法选择2000年1月—2017年1月我院神经外科、重症监护室(ICU)、急诊及在外院已行大骨瓣开颅术术后转入高压氧科的重型颅脑损伤病人112例作为研究对象,根据治疗方法不同分为研究组与对照组,各56例,对照组给予标准大骨瓣开颅术治疗,研究组在对照组基础上给予高压氧辅助治疗,以10 d为1个疗程,观察治疗3个疗程,记录并比较血流动力学及血清炎性因子变化。结果治疗后,两组格拉斯哥昏迷量表评分(GCS)显著高于治疗前(P<0.05),且研究组GCS评分显著高于对照组(P<0.05)。研究组治疗期间脑疝、下肢静脉血栓等并发症发生率为10.7%,显著低于对照组的32.1%(P<0.05)。治疗后,两组C反应蛋白水平显著低于治疗前(P<0.05),且研究组低于对照组(P<0.05)。治疗后,研究组大脑中动脉收缩末期峰值流速(Vp)和舒张期末期峰值流速(Vd)显著高于治疗前(P<0.05),且研究组Vp与Vd显著高于对照组(P<0.05)。结论高压氧辅助标准大骨瓣开颅术治疗重型颅脑损伤能减轻病人炎性因子的表达,减少继发性并发症的发生,改善颅内动脉血流动力学,从而起到显著脑保护作用,促进病人的预后康复。
引文
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[22] YU Y,CAO F,RAN Q,et al.Regulatory T cells exhibit neuroprotective effect in a mouse model of traumatic brain injury[J].Mol Med Rep,2016,14(6):5556-5566.
[23] DING Z,TONG WC,LU X X,et al.Hyperbaric oxygen therapy in acute ischemic stroke:a review[J].Interv Neurol,2014,2(4):201-211.
[24] 李大亮,黄雪敏,蒋劲柏,等.中心静脉-动脉血二氧化碳分压差联合中心静脉压行液体管理对重型颅脑外伤患者预后的影响[J].中国医刊,2016,51(11):94-99.
[2] SUN K,FAN J,HAN J.Ameliorating effects of traditional Chinese medicine preparation,Chinese materia medica and active compounds on ischemia/reperfusion-induced cerebral microcirculatory disturbances and neuron damage[J].Acta Pharm Sin B,2015,5(1):18-24.
[3] ZHOU H X,LIU Z G,LIU X J,et al.Umbilical cord-derived mesenchymal stem cell transplantation combined with hyperbaric oxygen treatment for repair of traumatic brain injury[J].Neural Regen Res,2016,11(1):107-113.
[4] WANG F,WANG Y,SUN T,et al.Hyperbaric oxygen therapy for the treatment of traumatic brain injury:a meta-analysis[J].Neurol Sci,2016,37(5):693-701.
[5] 万玉麟,徐黔.高压氧辅助标准大骨瓣开颅术对重型颅脑损伤患者血流动力学及血清炎性因子的影响[J].中华全科医学,2017,15(4):568-570;711.
[6] SHIH C C,TSAI S H,LIAO W I,et al.Successful treatment of epidural anesthesia-induced severe pneumocephalus by hyperbaric oxygen therapy[J].Am J Emerg Med,2015,33(8):1116.e1-1116.e3.
[7] STRENGER V,LACKNER H,MAYER R,et al.Incidence and clinical course of radionecrosis in children with brain tumors.A 20-year longitudinal observational study[J].Strahlenther Onkol,2013,189(9):759-764.
[8] 蒋汉刚,李峥,龚君豪,等.尼莫地平对重症颅脑损伤患者组织氧分压和血流动力学的影响[J].医学综述,2016,22(4):804-806;810.
[9] SANTINONI C D,OLIVEIRA H F,BATISTA V E,et al.Influence of low-level laser therapy on the healing of human bone maxillofacial defects:a systematic review[J].J Photochem Photobiol B,2017,169(2):83-89.
[10] SHI W Z,JU J Y,XIAO H J,et al.Dynamics of MMP-9,MMP-2 and TIMP-1 in a rat model of brain injury combined with traumatic heterotopic ossification[J].Mol Med Rep,2017,15(4):2129-2135.
[11] TAMARGO I A,BADER M,LI Y,et al.Novel GLP-1R/GIPR co-agonist "twincretin" is neuroprotective in cell and rodent models of mild traumatic brain injury[J].Exp Neurol,2017,2(288):176-186.
[12] XU Y,JI R,WEI R,et al.The efficacy of hyperbaric oxygen therapy on middle cerebral artery occlusion in animal studies:a meta-analysis[J].PLoS One,2016,11(2):324-331.
[13] 刘亚首.高压氧治疗原发性脑出血的作用机制研究进展[J].疑难病杂志,2016,15(6):646-649.
[14] ZHU X,WEI D,CHEN O,et al.Upregulation of CCL3/MIP-1 alpha regulated by MAPKs and NF-kappaB mediates microglial inflammatory response in LPS-induced brain injury[J].Acta Neurobiol Exp (Wars),2016,76(4):304-317.
[15] 栾宏权,黄贤键,姚柱炜,等.颅脑损伤患者血小板参数及无创脑血流动力学变化的临床意义[J].血栓与止血学,2016,22(3):260-263.
[16] TAO X G,SHI J H,HAO S Y,et al.Protective effects of calpain inhibition on neurovascular unit injury through downregulating nuclear factor-κB-related inflammation during traumatic brain injury in mice[J].Chin Med J (Engl),2017,130(2):187-198.
[17] 许燕凯,吴晋,马少玲,等.早期机械通气配合亚低温治疗重型颅脑损伤的疗效及对血清C反应蛋白和血液流变学的影响[J].中国基层医药,2016,23(17):2613-2616.
[18] LIN C,ChAO H,LI Z,et al.Omega-3 fatty acids regulate NLRP3 inflammasome activation and prevent behavior deficits after traumatic brain injury[J].Exp Neurol,2017,4(290):115-122.
[19] BRAWANSKI N,BAUMGARTEN P,KONCZALLA J,et al.Cerebral foreign body granuloma in brain triggering generalized seizures without obvious craniocerebral injury:a case report and review of the literature[J].Surg Neurol Int,2016,7(Suppl 29):775-778.
[20] 范丹峰,孟祥恩,胡慧军,等.中青年出血性脑卒中的高压氧综合治疗分析[J].转化医学杂志,2015(4):218-222.
[21] YAWNO T,SABARETNAM T,LI J,et al.Human amnion epithelial cells protect against white matter brain injury after repeated endotoxin exposure in the preterm ovine fetus[J].Cell Transplant,2017,26(4):541-553.
[22] YU Y,CAO F,RAN Q,et al.Regulatory T cells exhibit neuroprotective effect in a mouse model of traumatic brain injury[J].Mol Med Rep,2016,14(6):5556-5566.
[23] DING Z,TONG WC,LU X X,et al.Hyperbaric oxygen therapy in acute ischemic stroke:a review[J].Interv Neurol,2014,2(4):201-211.
[24] 李大亮,黄雪敏,蒋劲柏,等.中心静脉-动脉血二氧化碳分压差联合中心静脉压行液体管理对重型颅脑外伤患者预后的影响[J].中国医刊,2016,51(11):94-99.