关键词: 颅脑创伤, 颅内压监测, 阶梯减压术, 炎症反应, 代谢, 预后

Abstract: Objective To investigate the effect of stepped decompression under intracranial pressure monitoring on the inflammatory response,metabolic status and prognosis of patients with emergency craniocerebral trauma. Methods A total of 100 patients with trauma surgery  were randomly divided into two groups with 50 cases.The control group received conventional large bone flap decompression,and the observation group received stepped decompression.Inflammatory factors level were compared between 2 groups,and cerebral hemodynamics,protein metabolism and brain metabolism were monitored and compared between 2 groups. Results One week after operation,the inflammatory factors Monocyte chemoatrractant protein(MCP-1),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α)and interleukin 2(IL-2)in observation group were significantly lower，interleukin 2(IL-4)was higher than that in the control group.(P<0.05).The mean passage time(MTT) and peak time(TTP) of cerebral blood flow in the observation group were lower week and 1 month after surgery(P＜0.05),and the cerebral blood flow(CBF)andcerebral blood volume(CBV) were significantly higher(P＜0.05).One month after surgery,the expression levels of transferrin(TRE),retinol binding protein(RBP),and prealbumin(PA) in 2 groups were lower than before surgery,and the control group was significantly lower,cerebral metabolism [mixed venous oxygen saturation(SVO-2),cerebral oxygen uptake rate(CEO-2)] in 2 groups were all higher,and observation group was significantly higher(P<0.05).Conclusion Stepwise decompression under intracranial pressure monitoring can cause less injury to the body of patients with craniocerebral trauma,effectively reduce inflammatory response,and improve the metabolic state and prognosis.

Key words: craniocerebral trauma, intracranial pressure monitoring, stepped decompression, inflammatory response, metabolism, prognosis