摘要
目的探讨动态颅内压监测下阶梯式减压策略在老年外伤性颅脑损伤患者去骨瓣减压术中的应用效果。方法选取2019-03—2022-03石家庄市人民医院收治的102例老年外伤性颅脑损伤患者,对照组50例,观察组52例。对照组患者行常规去骨瓣减压术治疗,观察组患者采取动态颅内压监测下阶梯式减压策略的去骨瓣减压术,比较2组认知功能、神经功能、意识障碍程度、颅内压、血清指标及预后。结果术后1 d、3 d、7 d,观察组颅内压水平均明显低于对照组(P<0.05)。术后1、3个月观察组神经行为认知状态检查量表(NCSE)、格拉斯哥昏迷量表(GCS)评分明显高于同期对照组,美国国立卫生研究院卒中量表(NIHSS)评分明显低于同期对照组(P<0.05);术后1、3个月观察组血清胶质纤维酸性蛋白(GFAP)、S100B蛋白(S100B)、神经元特异性烯醇化酶(NSE)水平明显低于同期对照组(P<0.05);术后1、3个月观察组C反应蛋白(CRP)、白细胞计数(WBC)及降钙素原(PCT)明显低于同期对照组(P<0.05)。观察组预后良好率明显高于对照组(P<0.05)。结论在老年外伤性颅脑损伤患者中行动态颅内压监测下阶梯式减压策略的去骨瓣减压术,可有效降低其颅内压水平,加速神经功能恢复,改善预后。
Objective To investigate the prognosis of step wise decompressive craniotomy with dynamic intracranial pressure monitoring for the treatment of traumatic craniocerebral injury in the elderly.Methods The general data of 102 elderly patients with traumatic craniocerebral injury treated in Shijiazhuang People’s Hospital from March 2019 to March 2022 were retrospectively analyzed and were divided into control group(n=50)and ob⁃servation group(n=52).The control group received conventional decompressive craniotomy,and the observation group received step wise decompressive craniotomy under dynamic intracranial pressure monitoring.The cognitive function,neurological function,degree of consciousness disorder,intracranial pressure,serum indexes and progno⁃sis of the two groups were compared.Results The level of intracranial pressure in the observation group was sig⁃nificantly lower than that in the control group at 1-,3-and 7-day after operation(P<0.05).At 1-and 3-month af⁃ter operation,the scores of neurobehavioral cognitive status exam(NCSE)and Glasgow coma scale(GCS)in the observation group were significantly higher than those in the control group at the same period,and the National In⁃stitutes of Health stroke scale(NIHSS)scores were significantly lower than those in the control group at the same period(P<0.05).At 1-and 3-month after operation,the levels of glial fibrillary acidic protein(GFAP),S100B protein(S100B)and neuron specific enolase(NSE)in the observation group were significantly lower than those in the control group(P<0.05).At 1-and 3-month after operation,C-reactive protein(CRP),white blood cell count(WBC)and procalcitonin(PCT)in the observation group were significantly lower than those in the control group(P<0.05).The good prognosis rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion The step wise decompressive craniectomy with dynamic intracranial pressure moni⁃toring can effectively reduce the level of intracranial pressure in elderly patients with traumatic brain injury,pro⁃mote their neurological recovery and improve their prognosis.
作者
王东
张金峰
屈浙
李静
宋贺
WANG Dong;ZHANG Jinfeng;QU Zhe;LI Jing;SONG He(Shijiazhuang People’s Hospital,Shijiazhuang 050000,China)
出处
《中国实用神经疾病杂志》
2023年第7期853-859,共7页
Chinese Journal of Practical Nervous Diseases
基金
石家庄市科学技术研究与发展计划(编号:211460793)。
关键词
外伤性颅脑损伤
去骨瓣减压术
动态颅内压监测
阶梯式减压
预后
老年
Traumatic craniocerebral injury
Decompressive craniectomy
Dynamic intracranial pressure monitoring
Step wise decompression
Prognosis
Elderly
