2018 年第 9 期 第 13 卷

乌司他丁辅助低温控制性减压对重型颅脑损伤手术患者预后的影响

Effect of ulinastatin assisted hypothermia controlled decompression on prognosis of severe craniocerebral injury operation

作者：罗杰陈谦学

英文作者：

单位：430060武汉大学人民医院神经外科

英文单位：

关键词：重型颅脑损伤；乌司他丁；低温控制性减压；神经功能；预后

英文关键词：

• 摘要：

• 【摘要】目的    探讨乌司他丁辅助低温控制性减压对重型颅脑损伤手术患者预后的影响。方法    选择2014年1月至2016年11月在武汉大学人民医院行手术治疗的重型颅脑损伤患者116例，其中采用低温控制性减压治疗55例（对照组），采用乌司他丁辅助低温控制性减压治疗61例（观察组），回顾性分析2组患者临床资料，比较2组患者治疗前和治疗1、3 d的血浆内皮素与血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）及C反应蛋白，治疗前、治疗7 d的神经功能缺损程度量表（NIHSS）评分，对2组住院期间并发症的发生情况和随访6个月的格拉斯哥预后量表（GOS）分级进行比较。结果    治疗前，2组患者血浆内皮素与血清IL-6、TNF-α、C反应蛋白水平比较差异均无统计学意义（均P＞0.05）。治疗1 d，2组患者血浆内皮素与血清IL-6、TNF-α、C反应蛋白水平均低于治疗前，且观察组低于对照组，差异均有统计学意义（均P＜0.05）。治疗3 d，2组患者血浆内皮素与血清IL-6、TNF-α、C反应蛋白水平均低于治疗前和治疗1 d，且观察组低于对照组，差异均有统计学意义（均P＜0.05）。治疗7 d，观察组与对照组NIHSS评分均低于治疗前［(16.4±1.4)分比（35.3±1.3）分，(23.2±1.5)分比（35.2±1.4）分］，且观察组低于对照组，差异均有统计学意义（均P＜0.001）。观察组总并发症发生率低于对照组［13.1%(8/61)比34.5%（19/55）］，差异有统计学意义（χ2=6.287，P=0.012）。观察组随访6个月GOS分级明显优于对照组（P=0.045）。结论    乌司他丁辅助低温控制性减压可显著减轻重型颅脑损伤患者炎性反应，促进神经功能恢复，降低并发症发生率，并明显改善患者预后。

• 【Abstract】Objective    To investigate the effect of ulinastatin assisted hypothermia controlled decompression on the prognosis of patients with severe craniocerebral injury. Methods    Clinical data of 116 patients with severe craniocerebral injury who underwent surgical treatment in Renmin Hospital of Wuhan University from January 2014 to November 2016 were retrospectively analyzed; 55 cases were treated with hypothermia controlled decompression（control group）; 61 cases were treated with ulinastatin assisted hypothermia controlled decompression(observation group). Plasma endothelin, serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP), the National Institutes of Health Stroke Scale(NIHSS), complications and the Glasgow Outcome Scale(GOS) were analyzed. Results    There were no significant differences of endothelin, IL-6, TNF-α and CRP levels between groups before treatment（P＞0.05）. One day after treatment, endothelin, IL-6, TNF-α and CRP levels significantly decreased(P<0.05). Three days after treatment, these indicators significantly decreased compared to those at 1 day after treatment; the levels in the observation were significantly lower than those in the control group(P<0.05). Seven days after treatment, the NIHSS scores were significantly lower than those before treatment in both the observation group and control group［(16.4±1.4) vs （35.3±1.3）, (23.2±1.5) vs （35.2±1.4）］; the NIHSS score in the observation was significantly lower than that in the control group（P＜0.001）. Incidence rate of complications in the observation group was significantly lower than that in the control group［13.1%(8/61) vs 34.5%（19/55）］（χ2=6.287， P=0.012）. Six months after treatment, GOS grade in the observation group was superior to that in the control group(P=0.045). Conclusion    Ulinastatin assisted hypothermia controlled decompression treating severe craniocerebral injury can significantly reduce inflammatory response, promote the recovery of neurological function, reduce complications and improve the prognosis.