颅内微创穿刺血肿引流术治疗老年高血压脑出血的效果及对NT-proBNP、HMGB-1和GM-CSF水平的影响  

Clinical effect of minimally invasive hematoma drainage in the treatment of elderly patients with hypertensive cerebral hemorrhage and its effect on the levels of NT-pro BNP, HMGB-1 and GM-CSF

作　　者：陈果[1] 董伟[1] 

机构地区：[1]重庆市第五人民医院神经外科,重庆400062

出　　处：《中国医药导报》2016年第2期41-45,共5页China Medical Herald

基　　金：重庆市卫生和计划生育委员会医学科研计划项目(SZX2015187)

摘　　要：目的探讨颅内微创穿刺血肿引流术治疗老年高血压脑出血的效果及其对N末端脑钠肽前体（NT—proBNP）、高迁移率族蛋白1（HMGB-1）和血浆粒细胞巨噬细胞集落刺激因子（GM—CSr）水平的影响。方法选取2009年2月～2015年6月重庆市第五人民医院神经外科诊治的82例急性老年高血压脑出血患者为研究对象．根据手术方式的不同将患者分为颅内微创穿刺血肿引流术组（微创组）和小骨窗血肿清除术／去骨瓣减压血肿清除术（常规组），每组各41例，分别比较两组患者的临床疗效及其NT—proBNP、HMGB-1和GM—CSF的变化水平。结果术后7d和14d，两组出血量均较术前显著下降（P〈0．05），但两组组间比较差异无统计学意义（P〉0．05）。术后14d常规组格拉斯哥昏迷评分（GCS）和Barthel指数均较术前明显升高，而美国国立卫生研究院卒中量表（NIHSS）评分显著降低（P〈0.05）；微创组上述三项指标术后7d即出现明显改善（P〈0．05），且术后14dGCS评分和Barthel指数明显高于常规组，而NIHSS评分则显著低于常规组（P〈o．05）。术后微创组治疗有效率为75．61％（31／41），显著高于常规组的41．46％（17／41）（P〈0．05），但两组并发症发生率比较差异无统计学意义（P〉0．05）。术后7d和14d，微创组NT—proBNP、HMGB-1和GM—CSF水平均较术前显著下降（P〈0．05）；常规组仅在术后14d上述指标水平才出现明显降低（P〈0．05）；而且，微创组患者NT—proBNP、HMGB-1和GM—CSF水平均显著低于常规组（P〈0．05）。结论颅内微创穿刺血肿引流术可以有效清除老年高血压脑出血患者的出血病灶，调节脑内NT—proBNP、HMGB-1和GM—CSF水平，促进神经功能的恢复和生活质量的提高。Objective To investigate the clinical effect of minimally invasive hematoma drainage in the treatment of elderly patients with hypertension cerebral hemorrhage and its effect on the levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）, high mobility group box-1 protein （HMGB-1） and granulocyte-macrophage colony-stimulating factor （GM-CSF）. Methods Eighty two cases of elderly patients with acute hypertensive cerebral hemorrhage treated in Department of Neurosurgery of the Fifth People＇s Hospital of Chongqing from February 2009 to June 2015 were selected as research objects, and they were divided into minimally invasive intracranial hematoma puncture drainage surgery group （minimally invasive group） and small bone window hematoma/craniotomy hematoma surgery group （conventional group） according to different surgical procedures, each group had 41 cases. The clinical efficacy and the levels of NT-proBNP, HMGB-1 and GM-CSF were compared respectively between two groups. Results After operation for 7 days and 14 days, the bleeding volume of the two groups were significantly decreased compared with before operation （P 〈 0.05）, but there were no significant differences between the two groups （P 〉 0.05）. After operation for 14 days, the Glasgow coma scale （GCS） and Barthel index in the conventional group were significantly increased compared with before operation, whereas the national institute of health stroke scale （NIHSS） was markedly decreased （P 〈 0.05）; the three indexes above in the minimally invasive group were significantly improved after operation for 7 days （P 〈 0.05, and the GCS score and Barthel index at 14 days after operation of minimally invasive group were significantly higher than those of conventional group, while the NIHSS score was significantly lower than that of the conventional group （P 〈 0.05）. The effective rate of minimally invasive group was 75.61% （31/41）, which was significantly higher than that of the conventional group [

关 键 词：颅内微创穿刺血肿引流术 高血压脑出血 N末端脑钠肽前体 高迁移率族蛋白1 粒细胞巨噬细胞集落刺激因子 

分 类 号：R743.2[医药卫生—神经病学与精神病学]