| 王小言,夏鹰,金虎,等.脑脊液循环重建辅助治疗重型颅脑损伤的疗效及其对颅内压和神经元特异性烯醇化酶、超氧化物歧化酶、脑利钠肽的影响[J].安徽医药,2019,23(8):1520-1525. |
| 脑脊液循环重建辅助治疗重型颅脑损伤的疗效及其对颅内压和神经元特异性烯醇化酶、超氧化物歧化酶、脑利钠肽的影响 |
| The effect of cerebrospinal fluid circulation reconstruction in treating severe craniocerebral injury and its effect on intracranial pressure and NSE,SOD and BNP |
| 投稿时间：2018-03-07 |
| DOI： |
| 中文关键词: 颅脑损伤 减压颅骨切除术 颅内压 磷酸丙酮酸水合酶 超氧化物歧化酶 利钠肽,脑 脑脊液循环 |
| 英文关键词: Craniocerebral trauma Decompressive craniectomy Intracranial pressure Phosphopyruvate hydratase Superoxide dismutase Natriuretic peptide,brain Cerebrospinal fluid circulation |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨脑脊液循环重建术辅助治疗重型颅脑损伤的临床疗效及其对病人颅内压和神经元特异性烯醇化酶(NSE)、超氧化物歧化酶(SOD)和脑利钠肽(BNP)水平的影响。方法 选取2015年6月至2017年9月期间海口市人民医院收治的重型颅脑损伤病人134例,根据随机数字表法分为观察组和对照组,每组67例。对照组病人给予单纯标准去骨瓣减压术进行治疗；观察组病人在给予去骨瓣减压术的同时联合脑脊液循环重建术进行辅助治疗。比较两组病人治疗后的临床疗效、颅内压、神经功能、并发症发生和预后情况。结果 观察组手术减压完成时间(2.81±0.39)h明显长于对照组,差异有统计学意义(P<0.05)。观察组的Helsinki CT评分、ICU滞留时间(5.54±1.32)h及治疗后7 d内颅内压超过20 mmHg的累计时间(23.32±4.19)h均显著低于对照组,以上均差异有统计学意义(P<0.05)。观察组病人治疗后3 d、5 d、7 d颅内压[分别为(207.81±25.83)mmH2O,(190.07±22.18)mmH2O,(164.39±21.87)mmH2O]显著低于对照组病人,而格拉斯哥预后评分(GOS)[分别为(7.10±1.23)分,(8.26±1.62)分,(8.98±1.49)分]均显著高于对照组病人,以上差异有统计学意义(P<0.05)。观察组病人治疗后7 d的大脑神经功能分级(CPC)(1.31±0.36)分明显低于对照组,而欧洲卒中评分量表(ESS)评分(7.40±0.59)分明显高于对照组,以上差异有统计学意义(P<0.05)。观察组病人的血清NSE(23.31±2.36)ng/mL、一氧化氮(NO)(56.80±4.59)μmol/L、内皮素(ET)(57.40±6.59)pg/mL水平均显著低于对照组,而SOD水平(104.72±8.78)NU/mL明显高于对照组,以上差异有统计学意义(P<0.05)。观察组病人的血清抗利尿激素(ADH)(71.91±6.36)pg/mL和促肾上腺皮质激素(ACTH)(116.40±11.59)pg/mL均明显低于对照组,而BNP水平(30.79±2.58)pg/mL明显高于对照组病人,以上差异有统计学意义(P<0.05)。观察组脑水肿和脑梗死发生率均显著低于对照组,且脑水肿和脑梗死程度也明显轻于对照组病人,以上差异有统计学意义(P<0.05)。治疗后6个月,观察组病人的预后显著优于对照组,差异有统计学意义(P<0.05)。结论 脑脊液循环重建术辅助治疗重型颅脑损伤具有良好的临床疗效,能有效降低病人的颅内压,降低ADH和ACTH水平,升高BNP水平,改善神经功能的恢复,降低并发症的发生率,从而改善病人预后,值得在临床上进一步推广应用。 |
| 英文摘要: |
| Objective To explore the clinical effect of cerebrospinal fluid circulation revascularization in the treatment of severe head injury and its effects on neuron specific enolization enzyme (NSE),superoxide dismutase (SOD) and brain natriuretic peptide (BNP) levels.Methods Atotal of 134 patients with severe craniocerebral injury admitted to Haikou Municipal Hospital from June 2015 to September 2017 were selected and divided into observation group and control group according to random number table method,with 67 cases in each group.The patients in the control group were treated by simple standard decompression of bone flap.The patients in the observation group were treated with decompression combined with cerebrospinal fluid circulatory reconstruction.The clinical efficacy,intracranial pressure,neurological function,complications and prognosis were compared between the two groups.Results The duration of decompression was significantly longer in the observation group(2.81±0.39)h than that in the control group,and the difference was statistically significant (P<0.05).After treatment,the ICU stay time(5.54±1.32)h and cumulative time(23.32±4.19)h of intracranial pressure and intracranial pressure over 20 mmHg were significantly lower than those in the control group after treatment,and the difference were statistically significant (P<0.05).The intracranial pressure of observation group patients 3 d,5 d,7 d after treatment were [(207.81±25.83) mmH2O,(190.07±22.18) mmH2O,(164.39±21.87)mmH2O,respectively,which were significantly lower than those in the control group,and Glasgow outcome scale (GOS) [(7.10±1.23) score,(8.26±1.62)score,(8.98±1.49) score,respectively] were significantly higher than those of control group patients,the above differences were statistically significant (P< 0.05).Brain nerve function classification (CPC) (1.31±0.36) of observation group on the 7 d after treatment was significantly lower than that of the control group,while European stroke rating scale (ESS) score (7.40±0.59) was significantly higher than that of the control group,the above differences were statistically significant (P< 0.05).The serum NSE (23.31±2.36) ng/mL,nitric oxide (NO) (56.80±4.59) μmol/L,endothelin (ET) levels (57.40±6.59) pg/mL of observation group were significantly lower than those of the control group,and the SOD level (104.72±8.78)NU/mL obviously higher than that of control group,the above differences were statistically significant (P< 0.05).Serum antidiuretic hormone (ADH) (71.91±6.36) pg/mL and adrenocorticotropic hormone (ACTH) (116.40±11.59) pg/mL of the observation groupwere significantly lower than those of the control group,and the BNP levels (30.79±2.58) pg/mL was significantly higher than that of the control group,the above differences were statistically significant (P<0.05).The incidence and degree of cerebral edema and cerebral infarction were significantly lighter than those of the control group,the above differences were statistically significant (P<0.05).After 6 months of treatment,the prognosis of patients in the observation group was significantly better than that of the control group,and the difference was statistically significant (P<0.05).Conclusion Cerebrospinal fluid circulation has good clinical curative effect in treatment of severe head injury,which can effectively reduce the patients with intracranial pressure,ADH and ACTH levels and increase BNP levels,improve the recovery of neural function,reduce the incidence of complications and improve prognosis of patients and is worthy of further popularization and application in clinic. |
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