立体定向血肿抽吸术治疗轻中度自发性基底核区出血的临床效果及其对血清基质金属蛋白酶9、超敏C反应蛋白水平的影响  

Clinical Effect of Stereotactic Hematoma Aspiration on Mild to Moderate Spontaneous Basal Ganglia Hemorrhage and the Impact on Serum Levels of MMP-9 and hs-CRP

作　　者：廖洪民[1] 王勇[1] 黄建军[1] 辛元君 郑涛[1] 朱家伟[1] 刘旭[1] 

机构地区：[1]贵州航天医院神经外科,贵州省遵义市563003

出　　处：《实用心脑肺血管病杂志》2017年第6期88-92,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：中国航天科工集团医疗卫生科研项目(2014-LCYL-011)

摘　　要：目的观察立体定向血肿抽吸术治疗轻中度自发性基底核区出血的临床效果,探讨其对血清基质金属蛋白酶9(MMP-9)和超敏C反应蛋白(hs-CRP)水平的影响。方法选取2014—2016年贵州航天医院收治的自发性基底核区出血患者95例,根据出血量及治疗方法分为轻度出血行保守治疗者27例(A组)、轻度出血行立体定向血肿抽吸术者30例(B组)、中度出血行保守治疗者18例(C组)和中度出血行立体定向血肿抽吸术者20例(D组)。治疗后14 d,4组患者均复查CT,记录其血肿清除率及脑水肿体积;比较A组和B组、C组和D组患者治疗前及治疗后3、7、14 d血清MMP-9、hs-CRP水平;比较A组和B组、C组和D组患者治疗前及治疗后14、30 d美国国立卫生研究院卒中量表(NIHSS)评分;随访3个月,记录4组患者格拉斯哥预后量表(GOS)评分;观察B组和D组患者治疗期间并发症发生情况。结果治疗后14 d,B组和D组患者血肿清除率分别高于A组和C组,脑水肿体积分别小于A组和C组(P<0.05)。时间和方法在血清MMP-9和hs-CRP水平上存在交互作用(P<0.05);时间和方法在血清MMP-9和hs-CRP水平上主效应显著(P<0.05);治疗后3、7、14 d B组和D组患者血清MMP-9、hs-CRP水平分别低于A组和C组(P<0.05)。时间和方法在NIHSS评分上存在交互作用(P<0.05);时间和方法在NIHSS评分上主效应显著(P<0.05);治疗后14、30 d B组和D组患者NIHSS评分分别低于A组和C组(P<0.05)。随访3个月,B组和D组患者GOS评分分别高于A组和C组(P<0.05)。治疗期间,B组和D组患者发生再出血2例,均未发生手术相关死亡及颅内感染。结论立体定向血肿抽吸术治疗轻中度自发性基底核区出血的临床效果确切,可有效清除血肿、减轻脑水肿、降低血清MMP-9和hs-CRP水平并改善患者远期预后,且安全性较高。Objective To observe the clinical effect of stereotactic hematoma aspiration on mild to moderate spontaneous basal ganglia hemorrhage,to investigate the impact on serum levels of MMP-9 and hs-CRP. Methods A total of 95 patients with spontaneous basal ganglia hemorrhage were selected in the Aerospace Hospital of Guizhou Province from 2014 to2016,and they were divided into A group( with mild hemorrhage and treated by conservative treatment,n = 27),B group( with mild hemorrhage and treated by stereotactic hematoma aspiration,n = 30),C group( with moderate hemorrhage and treated by conservative treatment, n = 18) and D group( with moderate hemorrhage and treated by stereotactic hematoma aspiration,n = 20) according to bleeding amount and therapeutic methods. After 14 days of treatment,patients of the four groups received re-examination of CT to observe the hematoma clearance effect and encephaledema volume; serum levels of MMP-9 and hs-CRP before treatment,after 3 days,7 days and 14 days of treatment were compared between A group and B group,between C group and D group; NIHSS score before treatment,after 14 days and 30 days of treatment were compared between A group and B group,between C group and D group; patients of the four groups were followed up for 3 months,and the GOS score was recorded; incidence of complications of B group and D group was observed during the treatment,respectively. Results After14 days of treatment,hematoma clearance rate of B group was statistically significantly higher than that of A group,meanwhile hematoma clearance rate of D group was statistically significantly higher than that of C group( P < 0. 05); encephaledema volume of B group was statistically significantly smaller than that of A group, meanwhile encephaledema volume of D group was statistically significantly smaller than that of C group( P < 0. 05). There was interaction between time and method in serum levels of MMP-9 and hs-CRP( P < 0. 05); main effects of time and method were significant in serum levels of MMP-9 and hs-CRP(

关 键 词：出血 基底核 立体定向抽吸术 治疗结果 基质金属蛋白酶9 C反应蛋白质 

分 类 号：R743[医药卫生—神经病学与精神病学]