改良去骨瓣减压术治疗重型创伤性脑损伤的临床疗效研究

Clinical efficacy of modified decompressive craniectomy in severe traumatic brain injury

摘要:

目的 探讨改良去骨瓣减压术在重型创伤性脑损伤（sTBI）患者中的临床应用效果。方法 选取2023年1月—2025年12月于河南科技大学第一附属医院重症医学外科接受治疗的90例sTBI患者，依据手术方式不同分为试验组（改良去骨瓣减压术）与对照组（常规去骨瓣减压术），每组45例。比较两组颅内压、脑血流动力学［收缩期最大血流速度（Vs）、双侧颈内动脉搏动指数（PI）、平均血流速度（Vm）］、血清细胞因子［超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、血清神经元特异性烯醇化酶（NSE）、S-100钙结合蛋白B（S-100β）］水平、认知功能［简易精神状态（MMSE）评分］、术后并发症、预后［扩展格拉斯哥预后评分］。结果 试验组与对照组术前及术后1、3 d颅内压比较，结果 ①不同时间点的颅内压比较，差异有统计学意义（P <0.05）；②两组颅内压比较，差异有统计学意义（P <0.05），试验组术后1、3 d颅内压低于对照组；③两组颅内压变化趋势比较，差异有统计学意义（P <0.05）。试验组术后7 d的Vs、Vm均高于对照组，PI、hs-CRP、IL-6、IL-10、NSE、S-100β均低于对照组（P <0.05）。两组术后7 d的Vs、Vm均高于术前，PI、hs-CRP、IL-6、IL-10、NSE、S-100β均低于术前（P <0.05）。试验组术后2周的瞬时记忆、短时记忆、语言能力、定向力、视觉空间、注意力/计算力评分均高于对照组（P <0.05）。试验组术后并发症总发生率低于对照组（P <0.05）。试验组术后3个月预后良好率高于对照组（P <0.05）。结论 在sTBI患者中，改良去骨瓣减压术可有效缓解颅内压力异常，并改善脑血流循环及血流动力学状态，减轻炎症反应，降低神经损伤相关生物标志物水平，改善患者认知功能和预后，并降低术后并发症发生率。

Abstract:

Objective To investigate the clinical efficacy of modified decompressive craniectomy in patients with severe traumatic brain injury.Methods A total of 90 patients with severe traumatic brain injury who received treatment in the Department of Critical Care Surgery of the First Affiliated Hospital of Henan University of Science and Technology from January 2023 to December 2025 were enrolled. They were divided into an experimental group (modified decompressive craniectomy) and a control group (conventional decompressive craniectomy) according to the surgical method, with 45 cases in each group. The two groups were compared in terms of intracranial pressure (ICP), cerebral hemodynamics [maximum systolic velocity (Vs), pulsatility index (PI) of bilateral internal carotid arteries, mean flow velocity (Vm) ], serum cytokine levels [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), neuron-specific enolase (NSE), S100 calcium-binding protein B (S-100β) ], cognitive function [Mini-Mental State Examination (MMSE) score], postoperative complications, and prognosis [extended Glasgow outcome scale (GOSE) score].Results ICP comparisons between the experimental and control groups before surgery and at 1 and 3 days after surgery showed that there were statistically significant differences in ICP across different time points (P < 0.05) and between the two groups (P < 0.05), with lower ICP observed in the experimental group at 1 and 3 days after surgery compared with the control group. The trends of ICP changes over time differed significantly between the two groups (P < 0.05). At 7 days after surgery, the experimental group showed significantly higher Vs and Vm, and significantly lower PI and hs-CRP, IL-6, IL-10, NSE, and S-100β levels compared with the control group (P < 0.05). At 7 days postoperatively, Vs and Vm were significantly higher, while PI and hs-CRP, IL-6, IL-10, NSE, and S-100β levels were significantly lower than preoperative values in both groups (P < 0.05). At 2 weeks after surgery, scores of instantaneous memory, short-term memory, language ability, orientation, visuospatial function, and attention/calculation were significantly higher in the experimental group than in the control group (P < 0.05). The overall incidence of postoperative complications was significantly lower in the experimental group than in the control group (P < 0.05). The favorable prognosis rate at 3 months after surgery was significantly higher in the experimental group than in the control group (P < 0.05).Conclusion In patients with severe traumatic brain injury, modified decompressive craniectomy effectively alleviates intracranial hypertension, improves cerebral blood flow and hemodynamic status, reduces inflammatory responses, decreases levels of neurological injury biomarkers, enhances cognitive function and prognosis, and reduces postoperative complications.