Efficacy analysis of intracranial hematoma evacuation combined with decompressive craniectomy for traumatic brain injury patients

doi:10.3877/cma.j.issn.2095-9141.2025.03.004

Abstract

Abstract:

Objective

To explore the effect of intracranial hematoma evacuation combined with decompressive craniectomy in the treatment of traumatic brain injury (TBI) patients.

Methods

The clinical data of 94 patients with TBI in Neurosurgery Department of Nanjing Luhe People's Hospital were retrospectively analyzed from January 2020 to January 2024. The patients who underwent intracranial hematoma evacuation and decompressive craniectomy were included in experimental group (49 cases), while those who underwent intracranial hematoma evacuation and bone flap reduction were included in control group (45 cases). The postoperative hematoma clearance rate, intracranial rebleeding rate, and incidence of complications were compared between two groups of patients. The changes in preoperative and postoperative GCS scores, intracranial pressure levels, coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer], serum inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT)], and vasoactive factors [vascular endothelial growth factor (VEGF), angiogenin-1 (Ang-1)] were analyzed. The patients were followed up for 3 months, and the prognosis (GOS grading) of two groups of patients was compared.

Results

At 7 d after surgery, the GCS score in both groups was significantly enhanced than that before surgery; While PT and APTT were extended, intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were decreased than before surgery (P<0.05). The GCS score, the hematoma clearance rate, and the intracranial rebleeding rate in experimental group was higher than that in control group while the intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were lower than that in control group (P<0.05). There were no obvious differences in the incidence rates of complications between two groups (P>0.05). After 3 months of follow-up, there was no obvious difference in GOS grading between both groups (P>0.05).

Conclusions

For patients with TBI, intracranial hematoma evacuation combined with decompressive craniectomy can not only effectively removes the hematoma, but also optimize coagulation function, inhibit inflammatory factors, and regulate vascular active factors. Its therapeutic efficacy is superior to that of intracranial hematoma evacuation and bone flap reduction.

Key words: Traumatic brain injury, Intracranial hematoma evacuation, Decompressive craniectomy, Bone flap reduction, Neurological function, Coagulation function

Jiuqiang Fang, Yu Zhai, Junfeng Yang, Bin Shen. Efficacy analysis of intracranial hematoma evacuation combined with decompressive craniectomy for traumatic brain injury patients[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(03): 160-166.

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References 23

[1]	王霞,粱育磊,沈杰,等.重型颅脑损伤术后脑膨出的风险预测模型构建[J].中华神经创伤外科电子杂志, 2024, 10(6): 359-366. DOI: 10.3877/cma.j.issn.2095-9141.2024.06.007.
[2]	杜敬华,刘国军,王位坐.腰大池持续引流联合标准骨瓣减压治疗重型颅脑损伤的应用效果[J].四川大学学报(医学版), 2023, 54(5): 1040-1045. DOI: 10.12182/20230960203.
[3]	胡志恒,任洪波,宋志远,等.血清sTIM-3及其配体Gal-9、CEACAM-1与创伤性颅脑损伤患者脑损伤程度及预后的关系[J].中华脑科疾病与康复杂志(电子版), 2024, 14(4): 201-207. DOI: 10.3877/cma.j.issn.2095-123X.2024.04.002.
[4]	申皓宇,黄子芮,梁文佳,等.颅内压监测在颅脑创伤去骨瓣减压术中的作用[J].中华神经外科杂志, 2024, 40(6): 581-585. DOI: 10.3760/cma.j.cn112050-20231116-00172.
[5]	王婷婷,蔺洁璐,李静,等.上肢康复机器人联合VR训练对重症颅脑损伤术后干预效果及对日常行为的中介效应研究[J].机器人外科学杂志(中英文), 2024, 5(6): 1142-1148. DOI: 10.12180/j.issn.2096-7721.2024.06.023.
[6]	王东,张金峰,屈浙,等.动态颅内压监测下阶梯式减压策略在外伤性颅脑损伤去骨瓣减压术中的效果[J].中国实用神经疾病杂志, 2023, 26(7): 853-859. DOI: 10.12083/SYSJ.230243.
[7]	中国医师协会神经外科医师分会,中国神经创伤专家委员会.中国颅脑创伤外科手术指南[J].中华神经创伤外科电子杂志, 2015, 1(1): 59-60. DOI: 10.3877/cma.j.issn.2095-9141.2015.01.018.
[8]	Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale[J]. Lancet, 1974, 2(7872): 81-84. DOI: 10.1016/s0140-6736(74)91639-0.
[9]	顾永,任艳明,杨朝华,等.去骨瓣减压术在重型颅脑损伤中的应用进展[J].西部医学, 2022, 34(6): 932-936,封3. DOI: 10.3969/j.issn.1672-3511.2022.06.031.
[10]	李奕秋,沈冠豪,沈绍星,等.实时CT定位下脑内血肿清除术对脑出血患者预后及神经功能的影响[J].海军医学杂志, 2020, 41(4): 457-460. DOI: 10.3969/j.issn.1009-0754.2020.04.036.
[11]	张华军,齐文涛,段晓春,等.眶上外侧入路联合颅内压监测治疗破裂颅内动脉瘤效果评价[J].中国实用神经疾病杂志, 2023, 26(9): 1085-1090. DOI: 10.12083/SYSJ.230407.
[12]	张明,葛继晖,韩冰,等.颅内压相关参数在大面积脑梗死去骨瓣减压术后的临床应用[J].中华实验外科杂志, 2024, 41(5): 1058-1063. DOI: 10.3760/cma.j.cn421213-20240226-00207.
[13]	刘俊,黄贤键,高杰,等. Seldinger技术在开颅去骨瓣减压术后皮下积液治疗中的应用[J].中国微创外科杂志, 2022, 22(6): 523-525. DOI: 10.3969/j.issn.1009-6604.2022.06.018.
[14]	王明国,党帅,闫禹.改良去骨瓣减压术处理创伤性脑损伤的有效性和安全性及对炎性介质水平与预后的影响[J].解放军医学杂志, 2023, 48(11): 1338-1343. DOI: 10.11855/j.issn.0577-7402.1509.2023.0525.
[15]	蒙斯雅,李梅,李微.构建Logistic回归预测模型分析颅脑损伤患者并发凝血功能障碍的影响因素[J].中国急救复苏与灾害医学杂志, 2023, 18(3): 320-324. DOI: 10.3969/j.issn.1673-6966.2023.03.012.
[16]	刘帅,任洁,郭晓燕,等. TEG检测对颅脑损伤患者凝血功能及短期预后的应用价值探讨[J].检验医学与临床, 2022, 19(1): 102-104. DOI: 10.3969/j.issn.1672-9455.2022.01.027.
[17]	王武,程大鹏,郭锐.急性单发性创伤性颅脑损伤术后TNF-α、LPS、IL-6、PAF、PLA2及凝血功能水平与肝功能异常的相关性[J].临床和实验医学杂志, 2023, 22(23): 2477-2481. DOI: 10.3969/j.issn.1671-4695.2023.23.004.
[18]	罗刚,叶庆遥,彭景,等.丙泊酚靶控输注联合右美托咪定对颅脑外伤颅内血肿清除术患者血清炎症因子和脑损伤指标的影响[J].现代生物医学进展, 2024, 24(3): 507-511. DOI: 10.13241/j.cnki.pmb.2024.03.020.
[19]	高强,孙峻峰,张永斌.血清PCT、HMGB1、CRP/ALB预测颅脑损伤术后肺部感染的价值[J].检验医学与临床, 2023, 20(10): 1401-1404, 1409. DOI: 10.3969/j.issn.1672-9455.2023.10.013.
[20]	隋曌,严小虎,李英.超早期小骨窗微创血肿清除术治疗高血压脑出血效果及对血清血管内皮生长因子、血管生成素1和炎性因子影响[J].临床误诊误治, 2020, 33(2): 85-89. DOI: 10.3969/j.issn.1002-3429.2020.02.019.
[21]	张丽辉,李毓新,惠晶,等.鼠神经生长因子联合神经节苷脂钠注射液对癫痫大鼠认知功能、血清NSE及海马神经元的影响及机制分析[J].现代生物医学进展, 2023, 23(8): 1442-1446. DOI: 10.13241/j.cnki.pmb.2023.08.008.
[22]	申雅洁,阴怀清,曹芳芳,等.依达拉奉注射液对高胆红素血症脑损伤新生大鼠血清S100B蛋白水平的影响[J].中西医结合心脑血管病杂志, 2017, 15(17): 2116-2119. DOI: 10.3969/j.issn.1672-1349.2017.17.009.
[23]	孙思辉,杨安强,贺杰.颅脑损伤患者血浆suPAR、凝血功能及血清钠离子水平与其病情、预后的关系[J].西部医学, 2023, 35(6): 885-888. DOI: 10.3969/j.issn.1672-3511.2023.06.019.

组别	例数	年龄（岁，±s）	性别[例（%）]		血肿体积（mL，±s）	致伤原因[例（%）]
组别	例数	年龄（岁，±s）	男	女	血肿体积（mL，±s）	车祸致伤	坠落致伤	砸伤	其他
对照组	45	49.22±5.47	25（55.56）	20（44.44）	51.49±3.87	21（46.67）	10（22.22）	4（8.89）	10（22.22）
试验组	49	49.77±5.06	27（55.10）	22（44.90）	51.60±3.57	25（51.02）	9（18.37）	5（10.20）	10（20.41）
t/χ²值		0.506	0.002		0.143	0.342
P值		0.614	0.965		0.886	0.952

组别	例数	年龄（岁，±s）	性别[例（%）]		血肿体积（mL，±s）	致伤原因[例（%）]
组别	例数	年龄（岁，±s）	男	女	血肿体积（mL，±s）	车祸致伤	坠落致伤	砸伤	其他
对照组	45	49.22±5.47	25（55.56）	20（44.44）	51.49±3.87	21（46.67）	10（22.22）	4（8.89）	10（22.22）
试验组	49	49.77±5.06	27（55.10）	22（44.90）	51.60±3.57	25（51.02）	9（18.37）	5（10.20）	10（20.41）
t/χ²值		0.506	0.002		0.143	0.342
P值		0.614	0.965		0.886	0.952

组别	例数	GCS评分（分，±s）				颅内压（mmHg，±s）				血肿清除率（%，±s）	颅内再出血[例（%）]
组别	例数	术前	术后7 d	t值	P值	术前	术后7 d	t值	P值	血肿清除率（%，±s）	颅内再出血[例（%）]
对照组	45	5.24±2.00	9.08±1.54	10.176	<0.001	45.11±5.00	14.18±3.56	33.804	<0.001	79.21±5.31	4（8.16）
试验组	49	5.27±1.94	10.54±1.21	16.134	<0.001	45.56±4.45	10.18±2.57	48.194	<0.001	83.89±5.52	13（26.53）
t/χ²值		0.074	4.992			0.462	6.283			4.182	4.928
P值		0.941	<0.001			0.645	<0.001			<0.001	0.026

组别	例数	GCS评分（分，±s）				颅内压（mmHg，±s）				血肿清除率（%，±s）	颅内再出血[例（%）]
组别	例数	术前	术后7 d	t值	P值	术前	术后7 d	t值	P值	血肿清除率（%，±s）	颅内再出血[例（%）]
对照组	45	5.24±2.00	9.08±1.54	10.176	<0.001	45.11±5.00	14.18±3.56	33.804	<0.001	79.21±5.31	4（8.16）
试验组	49	5.27±1.94	10.54±1.21	16.134	<0.001	45.56±4.45	10.18±2.57	48.194	<0.001	83.89±5.52	13（26.53）
t/χ²值		0.074	4.992			0.462	6.283			4.182	4.928
P值		0.941	<0.001			0.645	<0.001			<0.001	0.026

组别	例数	颅内感染	脑积水	脑膨出	脑疝	发生率[例（%）]
对照组	45	5	2	6	1	14（31.11）
试验组	49	7	5	2	3	17（34.69）
χ²值						0.136
P值						0.712

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