微创穿刺引流术治疗高血压性基底节区脑出血的效果  

Effect of minimally invasive puncture and drainage on hypertensive basal ganglia intracerebral hemorrhage

作　　者：白磊[1] 陈晨[1] 李军[1] 冯毅 严飞平 李志磊 霍国进 Bai Lei;Chen Chen;Li Jun;Feng Yi;Yan Feiping;Li Zhilei;Huo Guojin(Department of Neurosurgery ,Yulin First Hospital ,Yulin719000,Shaanxi Province ,China)

机构地区：[1]榆林市第一医院神经外科,719000

出　　处：《中华老年心脑血管病杂志》2018年第12期1290-1293,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的研究微创穿刺引流术治疗高血压性基底节区脑出血的效果及血清水通道蛋白4(AQP4)和Toll样受体4(TLR4)的表达。方法纳入高血压性基底节区脑出血患者122例,根据治疗方案分为对照组和观察组,每组61例,对照组用保守药物治疗,必要时行开颅血肿清除术,观察组采用早期微创穿刺引流术;对比2组28d美国国立卫生研究院卒中量表(NIHSS)和日常生活活动能力量表(ADL)评分,观察治疗1周和2周脑水肿体积、血清AQP4和TLR4水平,随访6个月,比较2组治疗有效率、并发症发生率和复发率。结果与对照组比较,观察组28d的NIHSS评分显著降低,ADL评分明显升高(P<0.05),治疗1周和2周脑水肿体积、血清AQP4及TLR4水平明显降低(P<0.05)。观察组总有效率明显高于对照组(88.5%vs 73.8%),并发症发生率和复发率明显低于对照组(8.2%vs 21.3%,6.6%vs 19.7%,P<0.05)。结论早期微创穿刺引流术治疗高血压性基底节区脑出血有较高的安全性和有效性,可改善神经功能康复和生活能力,减轻脑水肿,降低血清AQP4和TLR4表达水平。Objective to study the clinical effect of minimally invasive puncture and drainage on hy- pertensive basal ganglia intracerebral hemorrhage (HBGICH)and expression of AQP4and TLR4.Methods One hundred and twenty-two HBGICH patients admitted to our hospital were divided into control group (n=61)and observation group (n=61).The patients in control group received conservative drug therapy and craniotomy to remove hematoma when necessary while those in observation group underwent early minimally invasive puncture and drainage.Their NIHSS and ADL scores were recorded on day 28after treatment.The size of cerebral edema and expression levels of AQP4and TLR4were measured after 1and 2weeks of treatment.The pa- tients were followed up for 6months,during which the effective rate,incidence of complications and rate of recurrence were recorded.Results The NIHSS score was significantly lower while the ADL score was significantly higher in observation group than in control group on day 28after tretment (P<0.05).The size of cerebral edema was significantly smaller and the expression lev- els of AQP4and TLR4were significantly lower in observation group than in control group after 1 and 2weeks of treatment (P<0.05).The total effective rate was significantly higher while the in- cidence of complications and rate of recurrence were significantly lower in observation group than in control group (P<0.05).Conclusion Early minimally invasive puncture and drainage are safe and effective for HBGICH and can improve the neurological recovery and living ability,reduce the incidence of cerebral edema and the expression levels of AQP4and TLR4.

关 键 词：高血压 脑出血 外科手术 微创性 穿刺术 水通道蛋白质4 Toll样受体4 

分 类 号：R544.1[医药卫生—心血管疾病] R651.1[医药卫生—内科学]