天幕裂孔切开术联合大骨瓣减压术对重型颅脑损伤患者血清和脑脊液组织型纤溶酶原激活物及脑脊液动力学影响

doi:10.3969/j.issn.1671-7171.2018.08.005

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Abstract 【Objective】 To investigate the effect of large bone flap decompression combined with canopy splitting on serum tissue plasminogen activator and cerebrospinal fluid dynamics in patients with severe head injury. 【Methods】 A total of 192 patients with severe craniocerebral injury who were treated in our hospital from January 2012 to January 2017 were randomly divided into observation group and control group, with 96 cases in each group. The control group was treated with large bone flap decompression. The observation group was treated with canopy splitting combined with large bone flap decompression. The changes of serum and cerebrospinal fluid tissue plasminogen activator (tPA), postoperative intracranial pressure changes, and cerebrospinal fluid dynamics were compared between the two groups[(SS), (SS/RI), (SC/RI), (SE), (SC), R-R interval (RI) and (MSV), (MDV)]. 【Results】 Before the operation, there was no significant difference in intracranial pressure between the two groups (P>0.05). After operation, the intracranial pressure of both groups showed a downward trend. The intracranial pressure of the observation group was lower than that of d₁, d₃ and d7. Control group (P<0.05). After operation, serum and cerebrospinal fluid t-PA and plasma plasminogen activator inhibitor-1 (PAI-1) levels decreased in both groups. Serum and cerebrospinal fluid levels of t-PA and PAI-1 were observed in group d₁ after operation. There was no significant difference (P>0.05). The levels of t-PA and PAI-1 in serum and cerebrospinal fluid of the observation group were lower than those of the control group (P<0.05). Before operation, there was no significant difference in the level of immune function between the two groups (P>0.05). After operation, the levels of IgG, IgA and IgM in the two groups were higher than those before operation (P<0.05), and the level of IgG, IgA and IgM in observation group was significantly higher than that in the control group (P<0.05). There were no significant differences in SS, SS/RI and SC/RI between the two groups (P>0.05). The SE, SC, RI and MSV in the observation group were larger than those in the control group, and the MDV was smaller than the control group. The difference was statistically significant (P<0.05). There was a positive correlation between t-PA and PAI-1 expression in cerebrospinal fluid and plasma in the control group and the observation group. 【Conclusion】 Large bone flap decompression has a good effect in treating patients with severe craniocerebral injury. It can effectively improve the serum tissue plasminogen activator level in patients, and has a good influence on cerebrospinal fluid dynamics. It is worthy of clinical application.

Key words： Craniocerebral Trauma/SU Craniotomy/MT Decompression Surgical/MT

Received: 10 May 2018

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R651.15

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	HEXi-wu
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HEXi-wu,ZHANGQiang,LIYa-dong, et al. Effects of Canopy Splitting Combined with Large Bone Flap Decompression on Serum Tissue Plasminogen Activator and Cerebrospinal Fluid Dynamics in Patients with Severe Head Injury[J]. JOURNAL OF CLINICAL RESEARCH, 2018, 35(8): 1471-1473.

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http://www.jcr.net.cn/EN/10.3969/j.issn.1671-7171.2018.08.005 OR http://www.jcr.net.cn/EN/Y2018/V35/I8/1471

[1]	. [J]. JOURNAL OF CLINICAL RESEARCH, 2018, 35(7): 1335-1356.