摘要
目的研究标准大骨瓣减压术联合超早期多机制亚低温治疗重型颅脑损伤的临床价值。方法回顾性分析2013年7月至2014年1月本院收治的120例重型颅脑损伤患者资料，按照入院先后顺序分成对照组和观察组，每组60例。两组患者均伤后4～10h内全麻下行标准大骨瓣减压术，术后对照组常规治疗，观察组在对照组的基础上实施超早期亚低温治疗方案，包括伤后3h内冰毯降温，并持续至术后48h，同时持续静脉点滴金尔伦4-7d（2．4ms／d）；术中用15℃生理盐水反复冲洗硬膜腔及血肿腔，使脑表温度低至32℃-35℃。术后选择性头部冰帽或颈部大血管表面放置冰块降温等。比较术后颅内压的变化、预后评价及对血清NSE、MBP、S-10013蛋白含量及脑脊液AB水平影响。结果术后24h、48h、72h及1周，观察组颅内压分别为（20．2±1．6）、（16．5±2．9）、（16．5±1．7）、（12．8±3．5）mmHg（1mmHg=0．133kPa），显著低于对照组的（23．7±1．9）、（22．8±2．0）、（21．6±1．8）、（17．8±4．3）mmHg；术后1个月，观察组术后并发症发生率为5．0％，明显低于对照组的21．7％；对照组术后24h、48h、72h、96h脑脊液A13水平明显高于术前，观察组在同时间点的脑脊液AB水平则低于术前；T1～T4时脑脊液A13水平观察组明显低于对照组，与对照组比，观察组NSE、MBP及S-10013均显著降低。术后6个月观察组恢复良好率为70．0％，明显高于对照组的33.3％；两组比较，P〈0．05。结论标准外伤大骨瓣开颅术联合亚低温治疗重型颅脑损伤，优于单一开颅治疗，可通过降脑耗氧量、减轻炎症反应、抑制钙超载等多种机制综合发挥脑保护作用，明显改善患者预后，提高术后生存质量，值得进一步推广。
Objective To study the clinical value of standard large trauma craniotomy combined with super early hypothermia for severe head injury. Methods The data of 120 patients with severe head injury treated at our hospital from July, 2013 to January, 2014 were retrospectively analyzed. The patients were divided into a control group and an observation group according to the hospitalization order, 60 cases for each group. Both groups undertook standard large trauma craniotomy under general anesthesia within 4-10 h after trauma; after the surgery, the control group were routinely treated; and in addition, the observation group were treated with hypothermia, including decreasing the temperature with ice blanket from 3 h after trauma to 48 h after the surgery and continuously and intravenously dripping naloxone hydrochloride 2.4 mg/d for 4-7 d; during the surgery, the epidural cavity and hematoma cavity were repeatedly washed with 15℃ saline flushing until the temperature of brain surface decreased to 32℃ -35 ℃ ; after the surgery, the temperature was decreased by wearing ice cap or putting ice on neck vascular. The postoperative intracranial pressure, prognostic evaluation, the serum contents of NSE, MBP, and S-100 beta protein, and the cerebrospinal fluid levels of A beta were compared. Results 24, 48, and 72 h and 1 week after the surgery, the intracranial pressures were （ 20.2±1.6 ） , （ 16.5±2.9 ） , （ 16.5±1.7 ） , and （ 12.8±3.5 ） mmHg （ 1 mmHg=0.133 kPa ） in the observation group and were （ 23.7±1.9 ） , （ 22.8±2.0 ） , （ 21.6±1.8 ） , （ 17.8±4.3 ） mmHg in the control group. 1 month after the surgery, the incidence of complications was 5.0% in the observation group and was 21.7% in the control group. The cerebrospinal fluid A beta level was obviously higher 24, 48, 72, and 96 h after than before the surgery in the control group and waslower in the observation group. At T1 - T4, cerebrospinal fluid A beta level, NSE, MBP, and S-100[3were lower in the observation group tha
出处
《国际医药卫生导报》
2017年第3期326-330,共5页
International Medicine and Health Guidance News
关键词
大骨瓣开颅术
超早期
亚低温治疗
重型颅脑损伤
Standard large trauma craniotomy
Super early
Hypothermia treatment
Severe head injury
