醒脑静注射液联合改良去大骨瓣减压术对重型颅脑损伤患者术后颅内压及血清炎症因子水平的影响

摘要

目的:探讨醒脑静注射液联合改良去大骨瓣减压术对重型颅脑损伤(STBI)患者术后颅内压(ICP)及血清炎症因子水平的影响.方法:采用回顾性分析方法,选取2014年5月-2016年11月武汉市第三医院收治的STBI患者,根据治疗方案分为对照组与观察组,每组32例.对照组患者行改良去大骨瓣减压术和术后常规抗感染治疗,观察组患者行改良去大骨瓣减压术后静脉滴注醒脑静注射液30 mL,每天1次,连续治疗30 d.比较两组患者术后3、5、7d的ICP水平、格拉斯哥昏迷量表(GCS)评分;术前和术后7 d的血清炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素2(IL-2)、IL-6]水平;术前和术后1个月的生活质量量表(SF-36)评分;术后1个月的格拉斯哥预后量表(GOS)评级和并发症发生率.结果:两组患者基线资料差异无统计学意义(P>0.05).术前,两组患者的GCS评分、血清炎症因子水平和SF-36评分差异均无统计学意义(P>0. 05).观察组患者术后GOS评级优于对照组(P0. 05).结论:醒脑静注射液联合改良去大骨瓣减压术治疗STBI患者预后效果与单用改良去大骨瓣减压术比较有差异,可能优于单用改良去大骨瓣减压术.%OBJECTIVE: To explore the effects of Xingnaojing injection combined with modified large bone flap decompression on postoperative intracranial pressure (ICP) and serum inflammatory factors in patients with severe traumatic brain injury (STBI).METHODS: In retrospective analysis, STBI patients were selected from Wuhan Municipal Third Hospital during May 2014-Nov. 2016, and then divided into control group and observation group according to therapy plan, with 32 cases in each group. Control group received modified large bone flap decompression and rountine postoperative infection. Observation group was given Xingnaojing injection 30 mL, once a day, after modified large bone flap decompression, for consecutive 30 d. ICP levels and GCS score were compared between 2 groups 3, 5, 7 d after surgery. The levels of serum inflammatory factors (hs-CRP, TNF-α, IL-2, IL-6) were compared before surgery and 7 d after surgery. SF-36 score were observed before surgery and one month after surgery. GOS grading and the incidence of complication were observed one month after surgery. RESULTS: There was no statistical significance in baseline information between 2 groups (P>0. 05). Before surgery, there was no statistical significance in GCS score, serum inflammatory factor level or SF-36 score between 2 groups (P>0. 05). GOS grading of observation group was better than that of control group after surgery (P0. 05). CONCLUSIONS: Prognosis effect of Xingnaojing injection combined with modified large bone flap decompression may be better than modified large bone flap decompression alone in the treatment of STBI, and there is difference between them.