摘要
目的:探究天幕裂孔切开术联合标准大骨瓣减压术对重型颅脑损伤患者免疫功能及血清组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物-1(PAI-1)的影响。方法:选取我院收治的重型颅脑损伤患者80例,随机分为治疗组及对照组各40例;对照组采用标准大骨瓣减压术治疗,治疗组采用天幕裂孔切开术联合标准大骨瓣减压术治疗,观察两组术后颅内压变化,并对比治疗前后两组免疫功能及血清t-PA、PAI-1的变化及并发症发生情况。结果:治疗组术后治的颅内压和应激性溃疡、脑动脉梗死及脑积水等并发症发生率较对照组显著降低(P<0.05);两组术后1~7d血清和脑脊液t-PA、PAI-1水平均呈逐渐降低趋势,治疗组术后3d、7d时务低格及脑脊液t-PA、PAI-1水平均明显低于对照组(P<0.05);两组术后IgG、IgA、IgM水平和CD3^+、CD4^+、CD8^+T淋巴细胞比例明显高于术前,CD4^+/CD8^+值较术前明显下降(P<0.05)。结论:天幕裂孔切开术联合标准大骨瓣减压术治疗重型颅脑损伤患者疗效确切,对患者免疫功能及t-PA、PAI-1影响小,术后并发症发生率低,疗效确切。
Objective： To explore the effect of tentorium cerebelli hiatus incision in combined with standard large decom- pressive craniectomy on the immunological function and serum t-PA and PAI-1 in patients with severe craniocerebral injury. Methods： A total of 80 patients with severe craniocerebral injury who were admitted in our hospital were included in the study, and randomized into the treatment group and the control group with 40 cases in each group. The patients in the control group were given standard large decompressive craniectomy, while the patients in the treatment group were given tentorium cerebelli hiatus incision in combined with standard large decompressive craniectomy. The postoperative intracranial pressure in the two groups was observed. The immunological function, serum t-PA and PAI-1 levels, and the occurrence of complications before and after treatment in the two groups were compared. Results： The intracranial pressure and occurrence rate of stress ulcer,cerebral artery infarction, and hydrocephalus after operation in the treatment group were significantly reduced when compared with the control group （P〈0.05）. The serum and CSF t-PA and PAI-1 levels ld to 7d after operation in the two groups were gradually reduced. The serum and CSF t-PA and PAL1 levels 3d and 7d after operation in the treatment group were significant- ly lower than those in the control group （P〈0.05）. IgG, IgA, and IgM levels, and CD3＋ , CD4＋ , and CD8＋ after operation in the two groups were significantly elevated, but CD4＋/CD8＋ was significantly reduced when compared with before operation （P〈0.05）. Conclusions： Tentorium cerebelli hiatus incision in combined with standard large decompressive craniectomy in the treatment of severe craniocerebral injury has a small effect on the immunological function and serum t-PA and PAL1, and can reduce the occurrence rate of postoperative complications, with an accurate efficacy.
出处
《海南医学院学报》
CAS
2016年第24期3105-3107,3110,共4页
Journal of Hainan Medical University
基金
南通市卫计委青年基金项目(WQ2015011)~~
关键词
重型颅脑损伤
天幕裂孔切开术
标准大骨瓣减压术
免疫功能
T-PA
PAI-1
Severe craniocerebral injury, Tentorium cerebelli hiatus incision, Standard large decompressive craniecto- my, Immunological function, t-PA, PAI-1
