【摘要】 目的 探讨血流动力学、颅内压（ICP）及相关生化指标与重型颅脑损伤（sTBI）去骨瓣减压术（DC）后患者预后的关系及预测价值。方法 选取2023年10月至2025年3月三门峡市中心医院收治的80例DC术后发生并发症（硬膜下积液、术后再出血、脑积水、颅内感染、癫痫等）的sTBI患者为预后不良组，另选取同期80例去骨瓣减压术后未发生并发症的sTBI患者为预后良好组。比较两组临床资料、血流动力学[每搏变异度（SVV）、中心静脉-动脉二氧化碳分压差（Pcv-a CO₂）、大脑中动脉平均血流速度（MCA-Vm）、搏动指数（PI）]、ICP及相关生化指标，采用多因素Logistic回归分析探讨sTBI患者DC术后预后的影响因素;采用受试者工作特征（ROC）曲线分析血流动力学、颅内压及相关生化指标对sTBI患者DC术后预后的预测价值。结果 预后不良组的多发性创伤占比、C反应蛋白及乳酸水平高于预后良好组（P<0.05）。预后不良组ICP、SVV、Pcv-a CO₂、PI均高于预后良好组，MCA-Vm低于预后良好组（P<0.05）。多发性创伤、C反应蛋白、乳酸、ICP、SVV、Pcv-a CO₂、PI与术后预后不良呈正相关，MCA-Vm与术后预后不良呈负相关（P<0.05）。多发性创伤、C反应蛋白、乳酸、ICP、SVV、Pcv-a CO₂、MCA-Vm、PI均为sTBI患者DC术后预后的独立影响因素（P<0.05）。多发性创伤、C反应蛋白、乳酸、ICP、SVV、Pcv-a CO₂、MCA-Vm、PI联合预测sTBI患者预后的AUC为0.915（95%CI:0.864～0.951）（P<0.05）。结论 sTBI患者DC术后预后受多发性创伤、C反应蛋白、乳酸、ICP、SVV、Pcv-a CO₂、MCA-Vm、PI等多种因素影响，联合血流动力学、颅内压及相关生化指标对患者预后有一定预测价值。更多还原

【Abstract】 Objective To investigate the relationship between hemodynamics,intracranial pressure（ ICP）,related biochemical indicators and the prognosis of patients with severe traumatic brain injury（ sTBI）after decompressive craniectomy（ DC）,as well as their predictive value. Methods Eighty sTBI patients who developed complications（ subdural effusion,postoperative rebleeding,hydrocephalus,intracranial infection,epilepsy,etc.） after undergoing DC surgery at Sanmenxia Central Hospital from October 2023 to March 2025 were selected as the poor prognosis group,and 80 sTBI patients who underwent decompressive craniectomy without complications during the same period were selected as the good prognosis group. The clinical data,hemodynamics [stroke volume variability（ SVV）,central venous-arterial carbon dioxide pressure difference（ Pcv-aCO₂）,mean blood flow velocity of the middle cerebral artery（ MCA-Vm）,pulsatility index（ PI） ],ICP,and related biochemical indicators were compared between the two groups. Multivariate logistic regression analysis was used to study the factors influencing the prognosis of sTBI patients after DC surgery.Receiver operating characteristic（ ROC） curve analysis was employed to assess the predictive value of hemodynamics,intracranial pressure,and related biochemical indicators for the prognosis of sTBI patients after DC surgery. Results The proportion of patients with multiple traumas,C-reactive protein levels,and lactate levels in the poor prognosis group were higher than those in the good prognosis group（ P < 0. 05）. The ICP,SVV,Pcv-aCO₂,and PI in the poor prognosis group were all higher than those in the good prognosis group,while the MCA-Vm was lower（ P < 0. 05）. Multiple traumas,CRP,lactate,ICP,SVV,Pcv-aCO₂,PI were positively correlated with the poor postoperative prognosis in patients with sTBI,and MCA-Vm was negatively correlated with the poor postoperative prognosis in patients with sTBI（ P < 0. 05）. Multiple traumas,CRP,lactate,ICP,SVV,Pcv-aCO₂,MCA-Vm,and PI were independent factors affecting the postoperative prognosis of sTBI patients（ P < 0. 05）. The area under the curve（ AUC） for predicting the prognosis of sTBI patients using a combination of multiple traumas,CRP,lactate,ICP,SVV,Pcv-aCO₂,MCA-Vm,and PI was0. 915（ 95% CI: 0. 864-0. 951）（ P < 0. 05）. Conclusions The prognosis of sTBI patients after DC surgery is influenced by multiple factors such as multiple traumas,C-reactive protein,lactate,ICP,SVV,Pcv-aCO₂,MCA-Vm,and PI. Combining hemodynamic,intracranial pressure,and related biochemical indicators can provide certain predictive value for patient prognosis.更多还原