颅脑损伤后炎性细胞的变化及其与继发性脑损伤的关系

目的探讨颅脑损伤后患者外周血白细胞（WBC）及多形核嗜中性白细胞（PMN）的变化及其在继发性脑损害中的作用。方法选取伤后24h内入院的非手术治疗的颅脑损伤患者63例,于入院时、入院后24h、48h、72h及168h不同时间段采外周静脉血进行白细胞计数及分类,同时进行GCS评分,计算脑出血量及脑水肿体积,伤后6个月进行GOS评分,分析上述指标与WBC和PMN之间的关系。选取10例健康自愿者行WBC及PMN计数检查。结果颅脑损伤以后WBC及PMN先升高后下降,分别于伤后24h和48h达到高峰（P〈0.05）;伤后WBC及PMN与GCS评分呈负相关（P〈0.05）,GCS〈8分组WBC和PMN计数显著高于GCS≥8分组（P〈0.05）;颅脑损伤后脑出血量及脑水肿体积与WBC及PMN呈正相关（P〈0.05）;GOS评分与WBC及PMN呈负相关（P〈0.05）。结论颅脑损伤后WBC及PMN明显升高,且与伤情、出血量、水肿体积及预后有关,可能跟WBC及PMN对颅脑损伤后引起的继发性损害有关,WBC和PMN计数有助于对伤情、预后的判断。

Changes in Inflammatory Cells of Peripheral Blood and Its Relationship with Secondary Brain Insult in Patients with Craniocerebrl Injury

Objective To explore the change in the white blood cell （WBC） and polymorphonuelear neutrophil （PMN） of peripheral blood and its role in secondary brain insult in the patients with eranioeerebral injury. Methods WBC and PMN of the peripheral blood were determined 0, 24, 48, 72 and 168 hours after admission to hospital in 63 patients with eraniocerebral injury treated only by non-operation. The Glasgow eoma scale （GCS）, the volumes of eerebral hemorrhage and brain edema were evaluated at the same time. The Glasgow outeome scale （GOS）, was evaluated 6 months after the injury. The relationship of the ehanges in WBC and PMN with GCS or COS was analyzed. WBC and PMN of peripheral blood were also determined in 10 healthy adults. Results The eounts of WBC and PMN reaehed the peak value 24 and 48 hours after the injury. The eounts of WBC and PMN were negatively related with GCS （r=-0.657 and -0.541 respeetively, P〈0.05）. The eounts of WBC and PMN in the patients with GCS〈8 were signifieantly higher than that in the patients with GCS≥ 8 （P〈0.05）. The eerebral hemorrhage volume reaehed the peak value 24 hours after the injury and the volume of brain edema reaehed the peak value 168 hours after the injury. The eounts of WBC and PMN were positively related with the volumes of eerebral hemorrhage and of brain edema （P〈0.05）. GOS was negatively related with the eounts of WBC and PMN （P〈0.05）. Conclusion The eounts of WBC and PMN of peripheral blood whieh were signifieantly inereased after the eranioeerebral injury are related with GCS, volumes of hemorrhage and brain edema, and GOS. It is suggested that WBC and PMN play an important role in the secondary eerebral insult. The eounts of WBC and PMN may be helpful to the assessment of the conditions and prognoses in the patients with eranioeerebral injury.