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宋涛涛, 霍继浩, 常娜, 齐芳. 标准外伤大骨瓣开颅减压术对急诊额颞部重型颅脑损伤患者脑氧代谢功能的影响[J]. 实用临床医药杂志, 2020, 24(21): 57-60. DOI: 10.7619/jcmp.202021017
引用本文: 宋涛涛, 霍继浩, 常娜, 齐芳. 标准外伤大骨瓣开颅减压术对急诊额颞部重型颅脑损伤患者脑氧代谢功能的影响[J]. 实用临床医药杂志, 2020, 24(21): 57-60. DOI: 10.7619/jcmp.202021017
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SONG Taotao, HUO Jihao, CHANG Na, QI Fang. Effect of standard traumatic large bone flap decompressive craniotomy on cerebral oxygen metabolism function of patients with severe craniocerebral injury in frontal and temporal regions[J]. Journal of Clinical Medicine in Practice, 2020, 24(21): 57-60. DOI: 10.7619/jcmp.202021017
Citation: SONG Taotao, HUO Jihao, CHANG Na, QI Fang. Effect of standard traumatic large bone flap decompressive craniotomy on cerebral oxygen metabolism function of patients with severe craniocerebral injury in frontal and temporal regions[J]. Journal of Clinical Medicine in Practice, 2020, 24(21): 57-60. DOI: 10.7619/jcmp.202021017
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标准外伤大骨瓣开颅减压术对急诊额颞部重型颅脑损伤患者脑氧代谢功能的影响

Effect of standard traumatic large bone flap decompressive craniotomy on cerebral oxygen metabolism function of patients with severe craniocerebral injury in frontal and temporal regions

    摘要
  • 摘要: 目的 探讨标准外伤大骨瓣开颅减压术对急诊额颞部重型颅脑损伤患者脑氧代谢功能的影响。 方法 选取125例急诊额颞部重型颅脑损伤患者作为研究对象,根据抽签法分为对照组62例和观察组63例。对照组采用常规区域性骨瓣开颅手术治疗,观察组采用标准外伤大骨瓣开颅减压术治疗。比较2组手术效果［以格拉斯哥预后评分(GOS)为标准］和手术并发症发生情况,并比较2组术前及术后1、2、3 d的脑氧代谢指标［脑氧摄取率(CERO2)、颈内动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、颈内静脉血氧饱和度(SjvO2)］和血清神经元特异性烯醇化酶(NSE)水平。 结果 术后1、2、3 d时,2组CaO2、NSE水平均低于术前, CERO2、CjvO2、SjvO2水平均高于术前,差异有统计学意义(P<0.05); 术后2、3 d时,观察组CERO2、CjvO2、SjvO2水平高于对照组, CaO2、NSE水平低于对照组,差异均有统计学意义(P<0.05); 观察组术后有效率为79.37%, 高于对照组的41.94%, 差异有统计学意义(P<0.05); 观察组并发症发生率为4.76%, 低于对照组的17.74%, 差异有统计学意义(P<0.05)。 结论 采用标准外伤大骨瓣开颅减压术治疗急诊额颞部重型颅脑损伤,可改善患者脑氧代谢能力,加快神经功能恢复,提高治疗有效率,降低术后并发症发生率。

     

    Abstract: Objective To investigate the effect of standard traumatic large bone flap decompressive craniotomy on cerebral oxygen metabolism of patients with severe craniocerebral injury in frontal and temporal regions. Methods Totally 125 patients with severe craniocerebral injury in frontal and temporal regions were selected and divided into control group(n=62)and observation group(n=63)according to drawing lots. The control group was treated with conventional regional craniotomy, and the observation group was treated with standard traumatic large bone flap decompressive craniotomy. Surgical efficacy ［evaluated by Glasgow Outcome Scale(GOS)］ and complications were compared between the two groups. The cerebral oxygen metabolism indexes ［cerebral extraction rate of oxygen(CERO2), internal carotid artery oxygen content(CaO2), internal jugular vein oxygen content(CjvO2), internal jugular vein oxygen saturation(SjvO2)］and serum neuron specific enolase(NSE)were compared between the two groups before and 1 day, 2 and 3 days after operation. Results At 1 day, 2 and 3 days after operation, the levels of CaO2 and NSE in both groups decreased significantly, while the levels of CERO2, CjvO2 and SjvO2 increased significantly(P<0.05). At 2 and 3 days after operation, the levels of CERO2, CjvO2 and SjvO2 in the observation group - were significantly higher than those in the control group, while the levels of CaO2 and NSE were significantly lower than those in the control group(P<0.05). The postoperative effective rate of the observation group was 79.37%, which was significantly higher than 41.94% of the control group(P<0.05). The incidence of complications in the observation group was 4.76%, which was significantly lower than 17.74% in the control group(P<0.05). Conclusion Standard traumatic large bone flap decompressive craniotomy is effective in treatment of patients with severe craniocerebral injury in frontal and temporal regions, which can improve patients'cerebral oxygen metabolism, accelerate nerve function recovery, enhance postoperative efficiency and reduce incidence of postoperative complications.

     

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