摘要
Abstract
Objective To study the clinical value of standard large trauma craniotomy combined with super early hypothermia for severe head injury.Methods The data of 120 patients with severe head injury treated at our hospital from July,2013 to January,2014 were retrospectively analyzed.The patients were divided into a control group and an observation group according to the hospitalization order,60 cases for each group.Both groups undertook standard large trauma craniotomy under general anesthesia within 4-10 h after trauma;after the surgery,the control group were routinely treated;and in addition,the observation group were treated with hypothermia,including decreasing the temperature with ice blanket from 3 h after trauma to 48 h after the surgery and continuously and intravenously dripping naloxone hydrochloride 2.4 mg/d for 4-7 d;during the surgery,the epidural cavity and hematoma cavity were repeatedly washed with 15 ℃ saline flushing until the temperature of brain surface decreased to 32 ℃-35 ℃;after the surgery,the temperature was decreased by wearing ice cap or putting ice on neck vascular.The postoperative intracranial pressure,prognostic evaluation,the serum contents of NSE,MBP,and S-100 beta protein,and the cerebrospinal fluid levels of A beta were compared.Results 24,48,and 72 h and 1 week after the surgery,the intracranial pressures were (20.2±1.6),(16.5±2.9),(16.5±1.7),and (12.8±3.5) mmHg (1 mmHg=0.133 kPa) in the observation group and were (23.7±1.9),(22.8±2.0),(21.6±1.8),(17.8±4.3) mmHg in the control group.1 month after the surgery,the incidence of complications was 5.0％ in the observation group and was 21.7％ in the control group.The cerebrospinal fluid A beta level was obviously higher 24,48,72,and 96 h after than before the surgery in the control group and was lower in the observation group.At T1-T4,cerebrospinal fluid A beta level,NSE,MBP,and S-100βwere lower in the observation group than in the control group.6 months after the surgery,the good recovery rate was 70.0％ in observation group and was 33.3％ in the control group.Conclusions Standard large trauma craniotomy combined with super early hypothermia for severe head injury is better than only standard large trauma craniotomy,plays a role of brain protection by reducing cerebral oxygen consumption and inflammation reaction and inhibiting calcium overload and other comprehensive mechanisms,and can obviously improve the patients' prognosis and postoperative survival quality,so it worth being further generalized.关键词
大骨瓣开颅术/超早期/亚低温治疗/重型颅脑损伤Key words
Standard large trauma craniotomy/Super early/Hypothermia treatment/Severe head injury
