脑脊液循环重建联合去骨瓣减压术对颅脑损伤病人颅内压及缺氧诱导因子-1α、胶质纤维酸性蛋白和纤溶酶原激活物的影响

doi:10.3969/j.issn.1005-6483.2020.10.010

摘要/Abstract

摘要： 目的探讨脑脊液循环重建联合去骨瓣减压术对颅脑损伤病人颅内压及缺氧诱导因子（HIF）-1α、胶质纤维酸性蛋白(GFAP)和纤溶酶原激活物(t-PA)的影响。
方法 2017年6月～2019年6月在我院接受治疗的颅脑损伤病人125例，采用抽签法分为观察组(63例)和对照组(62例)。对照组给予去骨瓣减压术治疗，观察组在对照组的基础上给予脑脊液循环重建治疗。比较两组病人的临床疗效、血清HIF-1α、GFAP、t-PA、颅内压、格拉斯哥预后评分(GOS)、大脑神经功能分级(CPC)、欧洲卒中评分量表(ESS)评分变化情况及并发症发生情况。
结果两组总有效率分别为92.06%，72.58%，差异有统计学意义(P<0.05)；治疗前，两组血清HIF-1α、GFAP、t-PA水平无明显差异；治疗后，两组血清HIF-1α、GFAP、t-PA水平均显著改善，且观察组上述指标均低于对照组，差异有统计学意义(P<0.05)；治疗前，两组颅内压、GOS评分水平无明显差异；治疗后，两组颅内压、GOS评分水平均显著改善，且观察组颅内压低于对照组，GOS评分高于对照组，差异有统计学意义(P<0.05)；治疗前，两组CPC、ESS评分水平无明显差异；治疗后，两组CPC、ESS评分水平均显著改善，且观察CPC评分低于对照组，ESS评分高于对照组，差异有统计学意义(P<0.05)；两组并发症总发生率分别为9.52%、32.26%，差异有统计学意义(P<0.05)。
结论在颅脑损伤病人中应用脑脊液循环重建联合去骨瓣减压术效果显著，可有效改善病人颅内压及血清HIF-1α、GFAP、t-PA水平，并发症较少。

关键词: 脑脊液循环重建, 去骨瓣减压术, 颅脑损伤, 颅内压, 缺氧诱导因子-1α, 胶质纤维酸性蛋白, 纤溶酶原激活物

Abstract: Objective To study Curative efficacy of Cerebrospinal fluid circulation reconstruction combined with decompression of bone flap in treatment of Traumatic brain injuryand its effectson intracranial pressure and Hypoxia-inducible factor-1(HIF-1),glial fibrinoacidic protein(GFAP),plasminogen activator(t-PA).
Methods 125 patients with craniocerebral injury who were treated in our hospital from June 2017 to June 2019 were selected and divided into the observation group(n=63) and the control group(n=62) by lottery.The control group was treated with decompression of bone flap,and the observation group was treated with cerebrospinal fluid circulation reconstruction on the basis of the control group.The clinical efficacy,changes in serum HIF-1,GFAP,t-PA,intracranial pressure,Glasgow outcome score(GOS),cerebral nerve function scale(CPC),European stroke score scale(ESS) and complications were compared between the two groups.
Results The total effective rate of the two groups was 92.06% and 72.58%,respectively(P<0.05).Before treatment,there was no significant difference in serum HIF-1,GFAP and t-PA levels between the two groups.After treatment,serum HIF-1,GFAP and t-PA levels in both groups were significantly improved,and the above indicators in the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference in intracranial pressure and GOS score between the two groups.After treatment,intracranial pressure and GOS scores in both groups were significantly improved,and intracranial pressure was lower than the control group,and GOS scores were higher than the control group(P<0.05).Before treatment,there was no significant difference in CPC and ESS scores between the two groups.After treatment,CPC and ESS scores in both groups were significantly improved,and CPC scores were lower than the control group,and ESS scores were higher than the control group(P<0.05).The total incidence of complications in the two groups was 9.52% and 32.26%,with statistically significant differences(P<0.05).
Conclusion Cerebrospinal fluid circulation reconstruction combined with craniocerebral flap decompression in patients with craniocerebral injury has a significant effect,which can effectively improve patients’ intracranial pressure and serum HIF-1,GFAP,t-PA levels,and fewer complications.

Key words: cerebrospinal fluid circulation reconstruction, decompression of bone flap, head injury, intracranial pressure, hypoxia-inducible factor-1, glial fibrillary acidic protein, plasminogen activator

杨燕刘显明韩涛. 脑脊液循环重建联合去骨瓣减压术对颅脑损伤病人颅内压及缺氧诱导因子-1α、胶质纤维酸性蛋白和纤溶酶原激活物的影响[J]. 临床外科杂志, 2020, 28(10): 926-929.

YANG Yan, LIU Xianming, HAN Tao.. Curative efficacy of Cerebrospinal fluid circulation reconstruction combined with decompression of bone flap in treatment of Traumatic brain injuryand its effectson intracranial pressure and HIF-1,GFAP and t-pa[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(10): 926-929.

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