切换至 "中华医学电子期刊资源库"
高级检索
中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (02) : 91 -96. doi: 10.3877/cma.j.issn.2095-9141.2023.02.005

临床研究

控制性减压在治疗重型颅脑损伤中的应用
汤宏, 高灵, 高宁, 蒋俊文, 张吉坤, 李由, 陈伟明, 夏鹰†()   
  1. 570208　海南海口，中南大学湘雅医学院附属海口医院（海口市人民医院）神经外科
  • 收稿日期:2022-10-24 出版日期:2023-04-15
  • 通信作者: 夏鹰

Application of controlled decompression in the treatment of severe traumatic brain injury

Hong Tang, Ling Gao, Ning Gao, Junwen Jiang, Jikun Zhang, You Li, Weiming Chen, Ying Xia†()   

  1. Department of Neurosurgery, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine (Haikou People's Hospital), Haikou 570208, China
  • Received:2022-10-24 Published:2023-04-15
  • Corresponding author: Ying Xia
  • Supported by:
    Hainan Clinical Medical Center Grant(LCYX202309)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

汤宏, 高灵, 高宁, 蒋俊文, 张吉坤, 李由, 陈伟明, 夏鹰. 控制性减压在治疗重型颅脑损伤中的应用[J]. 中华神经创伤外科电子杂志, 2023, 09(02): 91-96.

Hong Tang, Ling Gao, Ning Gao, Junwen Jiang, Jikun Zhang, You Li, Weiming Chen, Ying Xia. Application of controlled decompression in the treatment of severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(02): 91-96.

目的

探讨控制性减压在治疗重型颅脑损伤（sTBI）的临床疗效。

方法

回顾性分析中南大学湘雅医学院附属海口医院神经外科自2018年9月至2021年9月应用控制性减压治疗的sTBI患者35例，设为控制性减压组；2015年1月至2018年1月应用常规开颅减压治疗的sTBI患者35例，设为常规性减压组。分析2组患者的临床资料、术后并发症、住院时间、住院费用及预后结果。

结果

控制性减压组患者的手术时间长于常规性减压组，恶性脑膨出比例明显低于常规性减压组，差异均有统计学意义（P>0.05）。控制性减压组患者术后并发症（脑积水和脑膨出）的发生率、住院时间及费用均明显低于常规性减压组患者，差异均有统计学意义（P>0.05）。随访6个月，控制性减压组患者中27例效果良好，3例重度残疾，3例植物生存状态，2例患者术后弥漫性脑肿胀死亡。35例常规减压组患者中18例效果尚可，8例重度残疾，4例植物生存状态，5例死亡。2组患者预后比较，差异有统计学意义（P<0.05）。

结论

控制性减压在治疗sTBI患者中效果明显，能改善部分患者的预后。

关键词: 重型颅脑损伤, 控制性减压, 脑肿胀, 预后
Objective

To explore the clinical efficacy of controlled decompression in the treatment of severe traumatic brain injury (sTBI).

Methods

Thirty five patients with sTBI treated by applying controlled decompression surgery from September 2018 to September 2021 in Neurosurgery Department of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine were enrolled into controlled decompression group, another 35 patients with sTBI treated by routine conventional decompression surgery from January 2015 to January 2018 were enrolled into conventional decompression group. The clinical data, complication, length of hospital stay, hospital costs and follow-up results of all cases were analyzed.

Results

The surgical time of patients in the controlled decompression group was longer than that in the conventional decompression group, and the proportion of malignant encephalocele was significantly lower than that in the conventional decompression group, with statistical significance (P>0.05). The incidence, hospitalization time, and cost of postoperative complications (hydrocephalus and encephalocele) in the controlled decompression group were significantly lower than those in the conventional decompression group, and the differences were statistically significant (P>0.05). Following up for 6 months, 27 patients in the controlled decompression group achieved good results, 3 patients had severe disability, 3 patients had vegetative survival status, and 2 patients died of postoperative diffuse brain swelling. Among the 35 patients patients in the conventional decompression group, 18 were effective, 8 were severely disabled, 4 were in vegetative state, and 5 died. There was a statistically significant difference in prognosis between the two groups (P<0.05).

Conclusion

Controlled decompression has a good effective in the treatment of patients with sTBI and could improve the prognosis of some patients.

Key words: Severe traumatic brain injury, Controlled decompression, Brain swelling, Prognosis
表1 2组患者一般临床资料比较
Tab.1 Comparison of the general clinical data of the two groups
组别 例数 男/女 年龄（岁，±s） 单纯伤/复合伤 就诊时间（min，±s） 瞳孔散大（有/无） 中线偏移距离（mm，±s）
控制性减压组 35 19/16 45.80±2.04 30/5 104.40±12.01 13/22 8.97±0.48
常规性减压组 35 25/10 41.80±2.17 26/9 91.11±9.44 10/25 9.82±0.49
t/χ2值   1.484 1.340 1.429 0.872 0.583 1.205
P值   0.138 0.185 0.232 0.386 0.445 0.233
图1 控制性减压患者术前术后影像学资料对比A~B：术前CT（A：环池显影不清；B：中线明显移位，脑室明显受压）；C~D：术后CT（C：环池显影清晰；D：中线居中，脑室受压明显缓解，对侧脑组织未见出血）
Fig.1 Comparison of preoperative and postoperative imaging data in patients with controlled decompression
图2 常规性减压患者术前术后影像学资料对比A~B：术前CT（A：环池显影不清，四脑室可见少许积血；B：中线移位，脑室明显受压，脑肿胀）；C~D：术后CT（C：环池显影较术前明显好转；D：中线仍有偏移，减压侧脑内可见出血，脑肿胀明显，骨窗膨出）
Fig.2 Comparison of preoperative and postoperative imaging data in patients with conventional decompression
表2 2组患者住院期间术后并发症比较[例（%）]
Tab.2 Comparison of postoperative complications during hospitalization between the two groups [n (%)]
组别 例数 脑积水 脑膨出 感染 脑梗死 癫痫
控制性减压组 35 2（5.71） 4（11.43） 7（20.00） 3（8.57） 3（8.57）
常规性减压组 35 8（22.86） 12（34.29） 9（25.70） 4（11.43） 1（2.86）
χ2值   4.200 5.185 0.324 0.159 1.061
P值   0.041 0.022 0.569 0.690 0.303
表3 2组患者住院时间和住院费用比较（±s）
Tab.3 Comparison of length of stay and hospital costs between the two groups (Mean±SD)
组别 例数 住院时间（d） 住院费用（元）
控制性减压组 35 49.31±3.25 80543±5641
常规性减压组 35 64.57±4.84 113715±6094
t值   2.615 3.995
P值   0.011 0.001
图3 2组患者术后即刻及6个月后的影像学资料对比A~C：控制性减压组；A：术前硬膜下血肿压迫脑组织，中线移位；B：术后中线居中；C：术后6个月，骨窗局部凹陷，脑室系统正常；D~F：常规性减压组；D：术前脑组织受压明显，中线移位，脑室受压变形；E：术后中线居中，对侧额部出现少许血肿；F：术后6个月，骨窗仍膨出
Fig.3 Comparison of imaging data between two groups immediately after surgery and 6 months later
表4 2组患者预后情况比较[例（%）]
Tab.4 Comparison of prognosis between the two groups [n (%)]
组别 例数 恢复良好 轻度残疾 重度残疾 植物生存状态 死亡 预后良好率
控制性减压组 35 18（51.43） 9（25.71） 3（8.57） 3（8.57） 2（5.71） 27（77.14）
常规性减压组 35 11（31.42） 7（20.00） 8（22.86） 4（11.43） 5（14.28） 18（51.43）
χ2值             5.040
P值             0.025
[1]
潘晓飞,曹鑫意,张崇辉,等.控制减压技术影响兔重型颅脑损伤后NDRG2表达机制[J].安徽医科大学学报, 2021, 56(11): 1824-1828. DOI: 10.19405/j.cnki.issn1000-1492.2021.11.029.
[2]
Farrell D, Bendo AA. Perioperative management of severe traumatic brain injury: what is new?[J]. Curr Anesthesiol Rep, 2018, 8(3): 279-289. DOI: 10.1007/s40140-018-0286-1.
[3]
Zhang C, Wang Y, Chen J. Controlled decompression alleviates early brain injury in rabbit intracranial hypertension model by regulating apoptosis/necroptosis[J]. Acta Cir Bras, 2021, 36(4): e360406. DOI: 10.1590/ACB360406.
[4]
Yamal JM, Hannay HJ, Gopinath S, et al. Glasgow Outcome Scale measures and impact on analysis and results of a randomized clinical trial of severe traumatic brain injury[J]. J Neurotrauma, 2019, 36(17): 2484-2492. DOI: 10.1089/neu.2018.5939.
[5]
中国医师协会神经损伤培训委员会,中华医学会神经外科分会颅脑创伤学组,中国医师协会神经修复学专业委员会颅脑创伤修复学组.中国成人重型颅脑损伤大骨瓣开颅手术标准技术专家共识[J].中华神经创伤外科电子杂志, 2020, 6(2): 68-75. DOI: 10.3877/cma.j.issn.2095-9141.2020.02.002.
[6]
McLeod A. Traumatic injuries to the head and spine 1: mechanisms of injury[J]. Br J Nurs, 2004, 13(16): 940-947. DOI: 10.12968/bjon.2004.13.16.15963.
[7]
Qiu W, Guo C, Shen H, et al. Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury[J]. Crit Care, 2009, 13(6): R185. DOI: 10.1186/cc8178.
[8]
Jiang JY, Xu W, Li WP, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study[J]. J Neurotrauma, 2005, 22(6): 623-628. DOI: 10.1089/neu.2005.22.623.
[9]
Hutchinson PJ, Kolias AG, Timofeev IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension[J]. N Engl J Med, 2016, 375(12): 1119-1130. DOI: 10.1056/NEJMoa1605215.
[10]
Wang Y, Wang C, Yang L, et al. Controlled decompression for the treatment of severe head injury: a preliminary study[J]. Turk Neurosurg, 2014, 24(2): 214-20. DOI: 10.5137/1019-5149.JTN.8135-13.1.
[11]
Chen J, Li M, Chen L, et al. The effect of controlled decompression for severe traumatic brain injury: a randomized, controlled trial[J]. Front Neurol, 2020, 11: 107. DOI: 10.3389/fneur.2020.00107.
[12]
Flint AC, Manley GT, Gean AD, et al. Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury[J]. J Neurotrauma, 2008, 25(5): 503-512. DOI: 10.1089/neu.2007.0442.
[13]
Yang XF, Wen L, Shen F, et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases[J]. Acta Neurochir (Wien), 2008, 150(12): 1241-1247. DOI: 10.1089/neu.2007.0442.
[14]
谢成仁,侯晓峰.对开颅减压术后高度并发对侧硬膜外血肿术前干预治疗病例分析[J].现代医学与健康研究电子杂志, 2018, 2(16): 36-37.
[15]
Chen T, Qian X, Zhu J, et al. Controlled decompression attenuates compressive injury following traumatic brain injury via TREK-1-mediated inhibition of necroptosis and neuroinflammation[J]. Oxid Med Cell Longev, 2021, 2021: 4280951. DOI: 10.1155/2021/4280951.
[16]
张开鑫,方宪清,程彪,等.早期分步控制性减压手术治疗重症高血压脑出血患者的疗效分析[J].临床神经外科杂志, 2020, 17(4): 434-438. DOI: 10.3969/j.issn.1672-7770.2020.04.016.
[1] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[2] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[3] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[4] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[5] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[6] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[7] 江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.
[8] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[9] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[10] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗：10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[11] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[12] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[13] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[14] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[15] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号