早期清除血性脑脊液治疗脑外伤的效果分析

Effect of early clearance of bloody cerebrospinal fluid in the treatment of traumatic brain injury

摘要:

目的 分析早期清除血性脑脊液治疗脑外伤的临床效果。方法 选取2023年7月—2025年1月无锡市第五人民医院收治的82例脑外伤患者，依据分层随机抽样法分为常规治疗（对照组）和早期清除血性脑脊液（试验组），各41例。对比两组疗效状况、颅内压、血清学指标［乳酸（Lac）、皮质醇（Cor）、去甲肾上腺素（NE）、C反应蛋白（CRP）］、神经功能［改良Rankin量表（MRS）评分、美国国立卫生研究院卒中量表（NIHSS）评分］、功能预后状况［格拉斯哥预后量表（GOS）评分、残疾分级量表（DRS）评分］、免疫细胞因子（CD4⁺ 、CD8⁺、CD4⁺/CD8⁺）的差异。结果 试验组治疗总有效率高于对照组（P <0.05）。试验组术后7 d颅内压水平低于对照组（P <0.05）。试验组术后2周Lac水平低于对照组（P <0.05）。试验组术后4周Cor、NE、CRP水平均低于对照组（P <0.05）。试验组术后4周MRS评分、NIHSS评分低于对照组（P <0.05）。试验组GOS评分等级高于对照组（P <0.05）。试验组术后4周DRS评分低于对照组（P <0.05）。试验组术后4周CD4⁺、CD8⁺、CD4⁺/CD8⁺水平均高于对照组（P <0.05）。结论 早期清除血性脑脊液对脑外伤患者的治疗效果显著，可以有效降低颅内压，改善血清指标和神经功能，同时提升患者的功能预后和免疫状态。

Abstract:

Objective To analyze the clinical effect of early clearance of bloody cerebrospinal fluid (CSF) in the treatment of traumatic brain injury.Methods A total of 82 patients with traumatic brain injury admitted to Wuxi Fifth People's Hospital from July 2023 to January 2025 were selected and divided into a group undergoing conventional treatment (control group, n = 41) and the other with early clearance of bloody CSF (experimental group, n = 41) by stratified random sampling. The clinical efficacy, intracranial pressure, serum indicators [lactic acid (Lac), cortisol (Cor), norepinephrine (NE), C-reactive protein (CRP) ], neurological function [Modified Rankin Scale (MRS) and National Institutes of Health Stroke Scale (NIHSS) scores], functional prognosis [Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS) scores], and immune function (CD4⁺, CD8⁺, CD4⁺/CD8⁺) were compared between the two groups.Results The overall effective rate in the experimental group was higher than that in the control group (P < 0.05). On postoperative day 7, the intracranial pressure in the experimental group was lower than that in the control group (P < 0.05). At 2 weeks postoperatively, the Lac level in the experimental group was lower than that in the control group (P < 0.05). At 4 weeks postoperatively, the levels of Cor, NE, and CRP in the experimental group were all lower than those in the control group (P < 0.05). At 4 weeks after surgery, the MRS and NIHSS scores in the experimental group were lower than those in the control group (P < 0.05). The GOS scores in the experimental group were higher than those in the control group (P < 0.05). The DRS scores at 4 weeks postoperatively were lower in the experimental group than in the control group (P < 0.05). In addition, the levels of CD4⁺, CD8⁺, and CD4⁺/CD8⁺ at 4 weeks postoperatively were significantly higher in the experimental group compared to the control group (P < 0.05).Conclusion Early clearance of bloody CSF has a significant therapeutic effect in patients with traumatic brain injury, effectively reducing intracranial pressure, improving serum biomarkers and neurological function, and enhancing both functional outcomes and immune status.