微创血肿穿刺术治疗高血压脑出血的疗效及其对炎性因子表达水平的影响  

The effect of minimally invasive hematoma puncture on the treatment of hypertensive cerebral hemorrhage and the expression of inflammatory factors

作　　者：左建东 刘文广[2] 倪洪早 谢鹏[2] 丁涟沭[1] 

机构地区：[1]南京医科大学附属淮安第一医院神经外科,江苏淮安223300 [2]淮安市第二人民医院神经外科,江苏淮安223001

出　　处：《南京医科大学学报（自然科学版）》2017年第10期1273-1277,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：淮安市科技支撑计划(HAS201518)

摘　　要：目的:通过对高血压脑出血患者采用微创血肿穿刺术治疗,评估其疗效及对炎性因子表达水平的影响。方法:对本院74例高血压脑出血患者依据建档顺序分2组,各37例。对照组采用小骨窗血肿清除术,研究组采用微创血肿穿刺术,术后3~6个月进行随访。对比两组手术情况、临床疗效、并发症发生率,评估术前及末次随访时两组神经功能缺损评分(NIHSS)、日常生活能力评分(BI)及检测其血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)]水平变化。结果:(1)手术情况:研究组手术用时(12.34±5.54)min,术中失血量(40.31±10.27)m L,下床活动时间(5.04±2.82)d,住院时间(16.30±2.61)d,均少于对照组,差异有统计学意义(P<0.05);(2)神经功能及日常生活能力:术前两组NIHSS评分及BI评分比较,差异无统计学意义(P>0.05),术后研究组NIHSS评分[(4.08±1.35)分]低于对照组[(6.49±1.13)分],BI评分[(60.63±8.08)分]高于对照组[(46.82±6.81)分],差异有统计学意义(P<0.05);(3)临床疗效:研究组治疗有效率91.89%(34/37)高于对照组72.97%(27/37),差异有统计学意义(P<0.05);(4)血清炎性因子:术前两组hs-CRP、IL-6、TNF-α水平比较,差异无统计学意义(P>0.05),术后1周2组血清炎性因子水平均较术前降低,且研究组hs-CRP(7.14±3.05)mg/L、IL-6(14.18±3.16)ng/L、TNF-α(40.10±3.03)μg/L,低于对照组[(12.11±3.35)mg/L、IL-6(27.19±3.98)ng/L、TNF-α(53.22±3.32)μg/L],差异有统计学意义(P<0.05);(5)并发症发生率:研究组并发症发生率5.41%(2/37)低于对照组24.32%(9/37),差异有统计学意义(P<0.05)。结论:采用微创血肿穿刺术治疗高血压脑出血效果显著,可有效改善患者神经功能及日常生活能力,减少手术用时及术中失血量,降低血清炎性因子水平,提高治疗效果,且安全性较高。Objective： To investigate the curative effect of minimally invasive hematoma puncture in the treatment of hypertensive cerebral hemorrhage and the effect on the nerve function and the expression of inflammatory factors in patients with hypertensive cerebral hemorrhage. Methods： A total of 74 hypertensive cerebral hemorrhage patients were selected and grouped according to the filing order of hypertensive cerebral hemorrhage from October 2013 to August 2015, 37 cases in each group. The control group was treated with small bone window hematoma, the study group was treated with minimally invasive hematoma puncture. The patients were followed up from 3 to 6 months. After surgery, we compared the statistical operation, clinical efficacy, complications, analysis of preoperative and last follow-up two group of neural function defect score （NIHSS）, daily life ability score （BI） and serum inflammatory factor [tumor necrosis factor alpha （TNF-alpha）, interleukin-6 （IL-6）, high sensitive C reactive protein （hs-CRP） level change] of the two groups. Results： ① Operation： The operation time （12.34 ± 5.54） min, intraoperative blood loss （40.31 ± 10.27） mL, ambulation time （5.04 ± 2.82） d, and hospitalization time （16.30 ±2.61） d in the study group were less than those of the control group, the difference was statistically significant （P〈0.05）; ② Neurological function and ability of daily living： There was no significant difference in NIHSS score and BI score between the former two groups （P〉0.05）, after operation, the NIHSS score of the study group （4.08±1.35） was lower than that of the control group （6.49±1.13）, and the BI score （60.63±8.08） was higher than that of the control group （46.82±6.81）, and the difference was statistically significant （P〈0.05）; ③ Clinical effect： The effective rate of the study group was 91.89% （34/37）, which was higher than that of the control group 72.97% （27/37）, and the difference was statistica

关 键 词：微创血肿穿刺术 高血压脑出血 神经功能 炎性因子 

分 类 号：R651.1[医药卫生—外科学]