大骨瓣开颅减压术联合阶梯减压治疗重型创伤性脑损伤患者的临床研究

目的观察大骨瓣开颅减压术联合阶梯减压治疗重型创伤性脑损伤（TBI）的临床疗效，以及该术式对患者血流动力学、血清中转铁蛋白（TRF）及补体C1q肿瘤坏死因子相关蛋白（CTRP-3）水平的影响。 方法选取徐州市第三人民医院神经外科自2015年6月至2019年6月治疗的70例重型TBI患者，按照随机数字表法分为对照组和观察组，每组35例。对照组患者给予大骨瓣开颅减压术，观察组患者给予大骨瓣开颅减压术联合阶梯减压。比较2组患者治疗前后的血液动力学水平、GCS评分、TRF、CTRP-3水平以及术后并发症的发生率。所有患者随访6个月，对比其临床疗效。 结果2组患者术前双侧颈动脉平均血流速度（Vm）、峰值血流速度（PSV）及动脉搏动指数（PI）水平，差异均无统计学意义（P>0.05）；术后1、7 d的PSV、Vm及PI均优于术前，且观察组的PSV、Vm及PI均优于对照组，差异有统计学意义（P<0.05）；治疗前，2组患者的GSC评分、TRF及CTRP-3水平比较差异无统计学意义（P>0.05）；治疗后GCS评分、TRF及CTRP-3水平明显高于治疗前，且观察组增加幅度更高，差异有统计学意义（P<0.05）；治疗后观察组的预后良好率明显高于对照组，差异有统计学意义（P<0.05），而中度残疾率、重度残疾率、植物状态生存率及死亡率比较差异均无统计学意义（P>0.05）。 结论联合大骨瓣开颅减压术及阶梯减压治疗重型TBI具有良好的临床疗效，有助于改善患者血流动力学稳定，改善其蛋白质代谢指标，改善患者预后。

Clinical study on the treatment of severe traumatic brain injury with large bone flap craniotomy and step decompression

ObjectiveTo observe the clinical effect of large bone flap craniotomy combined with step decompression in the treatment of severe traumatic brain injury (TBI), and the effect of this operation on the hemodynamics, serum transferrin (TRF) and complement C1q tumor necrosis factor-related protein 3 (CTRP-3). MethodsA total of 70 patients with severe TBI treated in Department of Neurosurgery, Xuzhou Third People’s Hospital from June 2015 to June 2019 were divided into control group and observation group according to the random number table method, with 35 cases in each group. Patients in the control group were treated with large bone flap craniotomy, while patients in the observation group were treated with large bone flap craniotomy combined with step decompression. The level of hemodynamics, GCS, TRF, CTRP-3 and the incidence of postoperative complications were compared before and after treatment. All patients were followed up for 6 months to compare their clinical effects. ResultsThere was no significant difference in the levels of mean velocity (Vm), peak systolic velocity (PSV) and pulse index (PI) between the two groups (P>0.05). The PSV, VM and PI of 1 and 7 d after operation were better than those of before operation, PSV, VM and PI of the observation group were better than those of the control group (P<0.05). Before treatment, there was no significant difference in GSC score, TRF and CTRP-3 levels between the two groups (P>0.05); after treatment, GCS score, TRF and CTRP-3 levels were significantly higher than before treatment, and the increase rate of the observation group was higher, the difference was statistically significant (P<0.05); the good rate of the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05), while the moderate disability group was significantly better (P<0.05). There was no significant difference in the rates of severe disability, plant state survival and mortality (P>0.05). ConclusionThe combination of large bone flap craniotomy and step decompression has a good clinical effect in the treatment of severe TBI, which is helpful to improve the hemodynamic stability, protein metabolism index and prognosis of patients.