标准大骨瓣减压术对重型颅脑损伤患者免疫功能及炎症反应的影响(1)
【摘要】目的：探究重型颅脑损伤患者采取标准大骨瓣减压术治疗对其免疫功能与炎症反应的影响。方法：选择2017年4月-2018年4月期间在商丘市第一人民医院神经外二科治疗的50例重型颅脑损伤患者作为研究对象，按随机数表法分成2组，各25例。对照组采取常规开颅手术，观察组采取标准大骨瓣减压术，比较两组术后免疫功能指标与炎性因子水平。结果：观察组IgA、IgM、CD3+、CD4+水平均较对照组高，IL-2与TNF-α水平较对照组低，IL-4水平高于对照组，差异有统计学意义(P<005)。结论：标准大骨瓣减压术可显著改善重型颅脑损伤患者的免疫功能，降低炎症反应，降低颅内压，疗效确切。
【关键词】 重症颅脑损伤；标准大骨瓣减压术；免疫功能；炎症反应
【中图分类号】R742
【文献标志码】A
【文章编号】1005-0019(2018)06-030-01
, 百拇医药
Effect of standard large trauma craniotomy on immune function and inflammatory response in patients with severe craniocerebral injury
Li Jiandong (two Department of Neurosurgery， Shangqiu First People's Hospital， Shangqiu 476100， Henan)
Abstract Objective：To explore the effect of standard large trauma craniotomy on the immune function and inflammatory response in patients with severe craniocerebral injury.Methods： 50 cases of severe craniocerebral injury treated in two families of the Shangqiu First People's Hospital in April 2017 -2018 and April were selected as the subjects and divided into 2 groups according to the random number table method， and 25 cases each.The control group received conventional craniotomy， while the observation group received standard large bone flap decompression.The immune function and inflammatory factors were compared between the two groups after operation.Results： the level of IgA， IgM， CD3+ and CD4+ in the observation group was higher than that of the control group， and the level of IL-2 and TNF- alpha was lower than that of the control group， and the level of IL-4 was higher than that of the control group.The difference was statistically significant (P<005). Conclusion： standard large trauma decompression can significantly improve the immune function， reduce inflammatory reaction and reduce intracranial pressure in patients with severe craniocerebral injury.
, http://www.100md.com
Key words：Severe craniocerebral injury；standard large trauma craniotomy；immune function；inflammatory response
重型颅脑损伤多是由于外界因素导致头部损伤，与一般肢体损伤不同，颅脑损伤可导致患者神经系统出现不同程度损害，轻者头疼恶心、肢体功能与语言功能障碍，重者可出现呼吸功能与循环功能障碍，形成脑疝，对患者的生命安全造成威胁[1]。相关研究指出，颅脑损伤后继发性炎症可导致患者一个或多个器官衰竭，脑代谢异常与免疫功能障碍可影响患者预后，需及时采取有效的治疗措施[2]。本研究旨在探讨重型颅脑损伤患者采取标准大骨瓣减压术对患者免疫功能与炎症反应的影响。现报道如下。
1资料与方法
11一般资料选择2017年4月-2018年4月期间在商丘市第一人民医院神经外二科治疗的50例重型颅脑损伤患者作为研究对象，按随机数表法分成2组，各25例。对照组男14例，女11例；年龄21-74岁，平均(4791±543)岁；发病至手术时间05-15h，平均(076±026)h。观察组男15例，女10例；年龄22-73岁，平均(4763±556)岁；发病至手术时间04-15h，平均(074±025)h。兩组一般资料相比，差异无统计学意义(P>005)，具有可比性。本研究经我院伦理委员会批准，患者对本研究知情并签署同意书。
12方法对照行常规开颅手术，全麻后取仰卧位，患侧头部向健侧偏转40°，根据头部CT、MRI检查结果选择相应的额颞瓣进行开颅，行6×8cm减压窗，将血肿与坏死组织清除后进行止血。观察组行标准大骨瓣减压术，取颧弓上耳屏前方1cm左右行手术切口，延伸至顶骨正中线，顶部骨瓣旁侧矢状窦开2-3cm切口，打开脑中硬膜，清除硬膜外部血肿，行12×16cm减压窗，切开颞骨前部脑膜，切除硬膜下方及脑内部血肿，止血后采用人工脑硬膜或颞肌筋膜缝合创口。, http://www.100md.com(李建东)
【关键词】 重症颅脑损伤；标准大骨瓣减压术；免疫功能；炎症反应
【中图分类号】R742
【文献标志码】A
【文章编号】1005-0019(2018)06-030-01
, 百拇医药
Effect of standard large trauma craniotomy on immune function and inflammatory response in patients with severe craniocerebral injury
Li Jiandong (two Department of Neurosurgery， Shangqiu First People's Hospital， Shangqiu 476100， Henan)
Abstract Objective：To explore the effect of standard large trauma craniotomy on the immune function and inflammatory response in patients with severe craniocerebral injury.Methods： 50 cases of severe craniocerebral injury treated in two families of the Shangqiu First People's Hospital in April 2017 -2018 and April were selected as the subjects and divided into 2 groups according to the random number table method， and 25 cases each.The control group received conventional craniotomy， while the observation group received standard large bone flap decompression.The immune function and inflammatory factors were compared between the two groups after operation.Results： the level of IgA， IgM， CD3+ and CD4+ in the observation group was higher than that of the control group， and the level of IL-2 and TNF- alpha was lower than that of the control group， and the level of IL-4 was higher than that of the control group.The difference was statistically significant (P<005). Conclusion： standard large trauma decompression can significantly improve the immune function， reduce inflammatory reaction and reduce intracranial pressure in patients with severe craniocerebral injury.
, http://www.100md.com
Key words：Severe craniocerebral injury；standard large trauma craniotomy；immune function；inflammatory response
重型颅脑损伤多是由于外界因素导致头部损伤，与一般肢体损伤不同，颅脑损伤可导致患者神经系统出现不同程度损害，轻者头疼恶心、肢体功能与语言功能障碍，重者可出现呼吸功能与循环功能障碍，形成脑疝，对患者的生命安全造成威胁[1]。相关研究指出，颅脑损伤后继发性炎症可导致患者一个或多个器官衰竭，脑代谢异常与免疫功能障碍可影响患者预后，需及时采取有效的治疗措施[2]。本研究旨在探讨重型颅脑损伤患者采取标准大骨瓣减压术对患者免疫功能与炎症反应的影响。现报道如下。
1资料与方法
11一般资料选择2017年4月-2018年4月期间在商丘市第一人民医院神经外二科治疗的50例重型颅脑损伤患者作为研究对象，按随机数表法分成2组，各25例。对照组男14例，女11例；年龄21-74岁，平均(4791±543)岁；发病至手术时间05-15h，平均(076±026)h。观察组男15例，女10例；年龄22-73岁，平均(4763±556)岁；发病至手术时间04-15h，平均(074±025)h。兩组一般资料相比，差异无统计学意义(P>005)，具有可比性。本研究经我院伦理委员会批准，患者对本研究知情并签署同意书。
12方法对照行常规开颅手术，全麻后取仰卧位，患侧头部向健侧偏转40°，根据头部CT、MRI检查结果选择相应的额颞瓣进行开颅，行6×8cm减压窗，将血肿与坏死组织清除后进行止血。观察组行标准大骨瓣减压术，取颧弓上耳屏前方1cm左右行手术切口，延伸至顶骨正中线，顶部骨瓣旁侧矢状窦开2-3cm切口，打开脑中硬膜，清除硬膜外部血肿，行12×16cm减压窗，切开颞骨前部脑膜，切除硬膜下方及脑内部血肿，止血后采用人工脑硬膜或颞肌筋膜缝合创口。, http://www.100md.com(李建东)
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