摘要
目的 探讨重型颅脑损伤患者采用超低位去大骨瓣术+高压氧治疗的临床效果。方法 选取接受超低位去大骨瓣术的20例重型颅脑损伤患者作为对照组,同期接受超低位去大骨瓣术+高压氧治疗的20例重型颅脑损伤患者作为观察组。比较两组患者治疗前后颅内压、血清C反应蛋白、血清肿瘤坏死因子-α、神经功能缺损评分、昏迷评分、卡氏功能状态评分、日常生活能力评分、脑氧代谢指标[颈内静脉血氧分压(PjvO_(2))、颈内静脉血氧饱和度(SjvO_(2))、颈内静脉血氧含量(CjvO_(2))]、预后情况。结果 治疗后,两组患者颅内压、血清C反应蛋白、血清肿瘤坏死因子-α均低于治疗前,且观察组患者颅内压(13.49±2.01)mm Hg(1 mm Hg=0.133 kPa)、血清C反应蛋白(5.89±1.06)mg/L、血清肿瘤坏死因子-α(10.83±2.07)mg/L均低于对照组的(16.37±2.65)mm Hg、(7.02±1.27)mg/L、(13.49±2.46)mg/L,差异均具有统计学意义(P<0.05)。治疗后,两组患者神经功能缺损评分低于治疗前,昏迷评分、卡氏功能状态评分、日常生活能力评分高于治疗前,且观察组患者神经功能缺损评分(18.93±2.34)分低于对照组的(21.58±2.60)分,昏迷评分(12.95±1.23)分、卡氏功能状态评分(67.13±3.48)分、日常生活能力评分(82.96±7.15)分均高于对照组的(11.47±1.19)、(63.52±2.34)、(74.85±6.56)分,差异均具有统计学意义(P<0.05)。治疗后,两组患者PjvO_(2)、SjvO_(2)、CjvO_(2)均高于治疗前,且观察组患者PjvO_(2)(4.98±0.62)kPa、SjvO_(2)(59.52±3.57)%、CjvO_(2)(91.29±3.98)ml/L高于对照组的(4.35±0.60)kPa、(55.69±3.86)%、(86.71±3.72)ml/L,差异均具有统计学意义(P<0.05)。观察组预后良好率95.00%略高于对照组的80.00%,但差异无统计学意义(P>0.05)。结论 在重型颅脑损伤患者中,应用超低位去大骨瓣术联合高压氧治疗可控制颅内压和炎症反应,减轻神经功能损伤和意识障碍,促使脑氧代谢恢复,有利于改善预后。
Objective To discuss the clinical effect of ultra-low decompressive craniectomy combined with hyperbaric oxygen therapy in patients with severe craniocerebral injury.Methods 20 patients with severe craniocerebral injury who received ultra-low decompressive craniectomy were selected as the control group,and 20 patients with severe traumatic brain injury who received ultra-low decompressive craniectomy and hyperbaric oxygen therapy during the same period were selected as the observation group.Both groups were compared in terms of intracranial pressure,serum C-reactive protein,serum tumor necrosis factor-α,neurological deficit score,coma score,Karnofsky performance status score,activities of daily living score,cerebral oxygen metabolism indexes[jugular venous oxygen pressure(PjvO_(2)),jugular venous oxygen saturation(SjvO_(2)),jugular vein oxygen content content(CjvO_(2))]before and after treatment,and prognosis.Results After treatment,the intracranial pressure,serum C-reactive protein,and serum tumor necrosis factor-αin both groups were lower than those before treatment in this group;the intracranial pressure(13.49±2.01)mm Hg(1 mm Hg=0.133 kPa),serum C-reactive protein(5.89±1.06)mg/L,and serum tumor necrosis factor-α(10.83±2.07)mg/L in the observation group were lower than(16.37±2.65)mm Hg,(7.02±1.27)mg/L,and(13.49±2.46)mg/L in the control group;the differences were all statistically significant(P<0.05).After treatment,the neurological deficit score of the two groups was lower than that of this group before treatment,and the coma score,Karnofsky performance status score and activities of daily living score were higher than those of this group before treatment;the neurological deficit score(18.93±2.34)points of the observation group was lower than(21.58±2.60)points of the control group,and the coma score(12.95±1.23)points,Karnofsky performance status score(67.13±3.48)points and activities of daily living score(82.96±7.15)points were higher than(11.47±1.19),(63.52±2.34)and(74.85±6.56)points of the control group;the differences were all statistically significant(P<0.05).After treatment,the PjvO_(2),SjvO_(2) and CjvO_(2) in the two groups were higher than those before treatment in this group;the PjvO_(2)(4.98±0.62)kPa,SjvO_(2)(59.52±3.57)%,and CjvO_(2)(91.29±3.98)ml/L in the observation group were higher than(4.35±0.60)kPa,(55.69±3.86)%,(86.71±3.72)ml/L in the control group;the differences were all statistically significant(P<0.05).The good prognosis rate of the observation group was 95.00%,which was slightly higher than 80.00%of the control group,but the difference was not statistically significant(P>0.05).Conclusion For patients with severe craniocerebral injury,ultra-low decompressive craniectomy combined with hyperbaric oxygen therapy can control intracranial pressure and inflammatory reaction,reduce neurological injury and disturbance of consciousness,promote the recovery of cerebral oxygen metabolism,and improve the prognosis.
作者
杨荣思
YANG Rong-si(Department of Neurosurgery,Shishi General Hospital,Quanzhou 362700,China)
出处
《中国现代药物应用》
2022年第19期18-21,共4页
Chinese Journal of Modern Drug Application
关键词
重型颅脑损伤
超低位去大骨瓣术
高压氧
神经外科
Severe craniocerebral injury
Ultra-low decompressive craniectomy
Hyperbaric oxygen therapy
Neurosurgery
