经天幕裂孔切开术联合标准大骨瓣减压术对重型颅脑损伤患者免疫功能及血清t-PA、PAI-1的影响

发布时间：2018-06-20 08:27

本文选题：重型颅脑损伤 + 天幕裂孔切开术　；参考：《海南医学院学报》2016年24期

【摘要】：目的:探究天幕裂孔切开术联合标准大骨瓣减压术对重型颅脑损伤患者免疫功能及血清组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物-1(PAI-1)的影响。方法:选取我院收治的重型颅脑损伤患者80例,随机分为治疗组及对照组各40例;对照组采用标准大骨瓣减压术治疗,治疗组采用天幕裂孔切开术联合标准大骨瓣减压术治疗,观察两组术后颅内压变化,并对比治疗前后两组免疫功能及血清t-PA、PAI-1的变化及并发症发生情况。结果:治疗组术后治的颅内压和应激性溃疡、脑动脉梗死及脑积水等并发症发生率较对照组显著降低(P0.05);两组术后1~7d血清和脑脊液t-PA、PAI-1水平均呈逐渐降低趋势,治疗组术后3d、7d时务低格及脑脊液t-PA、PAI-1水平均明显低于对照组(P0.05);两组术后IgG、IgA、IgM水平和CD3~+、CD4~+、CD8~+T淋巴细胞比例明显高于术前,CD4~+/CD8~+值较术前明显下降(P0.05)。结论:天幕裂孔切开术联合标准大骨瓣减压术治疗重型颅脑损伤患者疗效确切,对患者免疫功能及t-PA、PAI-1影响小,术后并发症发生率低,疗效确切。
[Abstract]:Objective: to investigate the effect of incision of tentorium fissure and decompression of standard large bone flap on immune function and serum tissue type plasminogen activator (TPA), plasminogen activator inhibitor (PAI-1) in patients with severe craniocerebral injury. Methods: 80 patients with severe craniocerebral injury in our hospital were randomly divided into treatment group and control group, the control group was treated with standard large bone flap decompression, and the treatment group was treated with sky-hole incision combined with standard large bone flap decompression. Intracranial pressure (ICP) was observed and the changes of immune function, serum t-PAAPAI-1 and complications before and after treatment were compared between the two groups. Results: the incidence of intracranial pressure, stress ulcer, cerebral artery infarction and hydrocephalus in the treatment group was significantly lower than that in the control group, and the levels of t-PAPPAI-1 in serum and cerebrospinal fluid decreased gradually in both groups on the 1st and 7th day after operation. The levels of t-PAP PAI-1 in CSF were significantly lower in the treatment group than those in the control group on the 3rd and 7th day after operation, and the levels of IgGG titer IgM and CD3 ~ + CD4 ~ + CD8 ~ T lymphocytes in the two groups were significantly higher than those in the preoperative patients (P 0.05) and the ratio of CD3 ~ + CD4 ~ + CD8 ~ T lymphocytes in the two groups was significantly lower than that in the control group (P < 0.05). Conclusion: the treatment of severe craniocerebral injury with the combination of tentorium fissure incision and standard large bone flap decompression is effective, and has little effect on the immune function and t-PAPPAI-1 of the patients, and the incidence of postoperative complications is low, and the curative effect is definite.
【作者单位】：江苏南通市第一人民医院神经外科;
【基金】：南通市卫计委青年基金项目(WQ2015011)~~
【分类号】：R651.15

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