摘要目的 探讨高压氧对重度颅脑损伤患者去骨瓣减压(decompressive craniectomy,DC)术后并发症的发生及预后的影响.方法 收集2010年1月至2014年12月烟台毓璜顶医院神经外科重度颅脑外伤行DC术的患者,按治疗方法分为高压氧组(86例)及常规组(74例),比较2组患者术后并发症的发生率、术后不同时期脑电图的变化、脑脊液转化生长因子β1(transforming factor-β1,TGF-β1)及髓鞘碱性蛋白(myelin basic protein,MBP)的含量、格拉斯哥昏迷指数(Glasgow coma scale,GCS)评分以及术后6个月改良性Rankin量表评分.结果 重度颅脑损伤去DC术后高压氧组脑膨出(31.4％)、术后癫痫(10.5％)、脑积水(11.6％)的发生率较常规组(分别为47.3％、23.0％、24.3％)降低,差异有统计学意义(P＜0.05).硬膜下积液的发生率,高压氧组(32.6％)与常规组(41.9％)比较差异无统计学意义(P＞0.05).术后14、21 d高压氧组较常规组脑脊液TGF-β1、MBP含量明显降低;术后1、3个月时高压氧组较常规组脑电图明显改善,GCS评分显著提高;术后6个月改良性Rankin量表评分高压氧组预后良好率明显高于常规组,差异均有统计学意义(P＜0.05).结论 重度颅脑损伤患者DC术后高压氧治疗可降低脑膨出、术后癫痫、脑积水的发生率,改善脑电图,降低术后14、21 d脑脊液TGF-β1、MBP含量,明显改善预后.

abstractsObjective To explore the effects of hyperbaric oxygen (HBO) on the incidence of complications and treatment efficacy following decompressive craniectomy(DC) in severe traumatic brain injury.Methods A total of 160 patients who underwent DC for severe traumatic brain injury from January 2010 to December 2014 in the Neurosurgery Department of Yantai Yuhuangding Hospital were chosen for the study.The subjects were divided into the HBO group (86 Patients) and the routine treatment group (74 patients) in accordance with different treatment methods.Incidence of complications,changes in EEG at different time points after surgery,the levels of transforming factor-β1 (TGF-β1) and myelin basic protein (MBP) in cerebrospinal fluid,scores of Glasgow Coma Scale as well as scores of Modified Rankin Scale 6 months after surgery were compared between the two groups.Results Following DC in severe traumatic brain injury,the rates of cerebral herniation (31.4％),postsurgical epilepsy (10.5％) and hydrocrania (11.6％) in the HBO group were all obviously decreased(47.3％,23.0％,24.3％),as compared with those of the control group,and statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.05).The incidence of subdural effusion in the HBO group was 32.6％,while that of the routine treatment group was 41.9％,and there was no statistical significance,when comparisons were made between the 2 groups (P ＞ 0.05).In the HBO group,the levels of TGF-β 1 and MBP in the cerebrospinal fluid 14 and 21 days after surgery were significantly decreased,as compared with those of the routine treatment group.The EEG and GCS scores in the HBO group were significantly improved,1 and 3 months after surgery,as compared with those of the routine treatment group.The scores of the modified Rankin Scale of the HBO group,which were obtained 6 months after surgery,were significantly higher than those of the routine treatment group,and statistical significance could be noted,when comparisons were made between the 2 groups (P ＜ 0.05).Conclusions Following decompressive cranioectomyin,HBO in the treatment of severe traumatic brain injury could obviously decrease the rates of cerebral herniation,postsurgical epilepsy and hydrocrania.HBO could also substantially improve EEG and decrease levels of TGF-β 1 and MBP,14 and 21 days after surgery,and improve the prognosis of the patients.