微创引流术对老年高血压脑出血患者炎性介质、脑出血标志物水平的影响  

Effect of minimally invasive drainage surgery on inflammatory mediators,cerebral hemorrhage markers in patients with hypertensive cerebral hemorrhage

作　　者：杨志明[1] 胡帮红[1] 杨波[1] 邱戈[1] 邱有波[1] 廖晓灵 YANG Zhiming;HU Banghong;YANG Bo;QIU Ge;QIU Youbo;LIAO Xiaoling(Department of Neurosurgery,Chongzhou People＇s Hospital, Sichuan Province, Chongzhou 611230,China)

机构地区：[1]四川省崇州市人民医院神经外科,611230

出　　处：《疑难病杂志》2018年第5期437-441,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的分析老年高血压脑出血患者行微创引流术治疗的效果及对血清炎性介质、脑出血标志物的影响。方法选择2014年2月—2017年2月四川省崇州市人民医院神经外科治疗的老年高血压脑出血患者120例作为研究对象,随机分成2组各60例。观察组患者应用微创钻孔引流术治疗,对照组应用传统开窗血肿清除术治疗。比较2组患者的手术情况、预后效果及手术前后血清炎性介质[C反应蛋白(CRP)、神经元特异性烯醇化酶(NSE)、神经营养因子-α(NTF-α)]、脑出血标志物[N末端脑钠肽前体(NT-pro BNP)、粒细胞巨噬细胞集落刺激因子(GM-CSF)、高迁移率族蛋白-1(HMGB-1)]及神经功能缺损程度评分(NIHSS)、Barthel指数的变化情况。结果观察组患者的手术时间、住院时间明显短于对照组(t=19.408、5.253,P=0.000、0.000),而再出血率2组间比较差异无统计学意义(χ~2=0.209,P=0.648);观察组患者的预后有效率为91.7%,高于对照组的76.7%(χ~2=5.065,P=0.024);2组患者的CRP、NSE及NTF-α水平均较手术前显著改善(t观察组=29.153、20.936、42.223,t对照组=20.712、15.783、22.046,P均=0.000),且观察组改善较对照组更显著(t=7.561、8.894、13.573,P均=0.000);2组患者的NT-pro BNP、GMCSF及HMGB-1水平均较手术前显著下降(t观察组=27.416、24.546、25.787,t_(对照组)=15.841、11.244、11.396,P均=0.000),并且观察组患者下降更为显著(t=13.143、14.603、22.288,P均=0.000);与治疗前比较,2组NIHSS评分均下降、Barthel指数均上升(t观察组=20.091、16.557,t对照组=12.243、9.160,P均=0.000),并且观察组变化更显著(t=12.386、7.189,P=0.000、0.000)。结论微创钻孔引流术治疗老年高血压脑出血的临床效果良好,能够显著改善神经功能、炎性反应,降低脑出血标志物水平,有助于改善患者的预后,值得加以推广。Objective To investigate the effect of minimally invasive drainage surgery on inflammatory mediators,cerebral hemorrhage markers in patients with hypertensive cerebral hemorrhage. Methods One hundred and twenty patients with hypertensive cerebral hemorrhage who were treated in department of neurosurgery of Chongzhou People＇s Hospital from February 2014 to February 2017 were selected. Patients were divided into the observation group （60 cases） and control group （60 cases）. The patients of control group were treated with traditional craniotomy hematoma removal surgery,while the patients of observation group were treated with minimally invasive drilling drainage surgery. Compare the surgery,prognosis and the changes of inflammatory mediators, which including C reactive protein （CRP）,neuron specific enolase （NSE）,neurotrophic factor alpha （NTF-α）,cerebral hemorrhage markers, which including N terminal pro brain natriuretic peptide （NT-proBNP）,Granulocyte macrophage colony stimulating factor （GM-CSF）,high mobility group boxin 1 （HMGB-1）,neurological deficit score （NIHSS）,Barthel index of two groups. Results In the operation time and length of stay,the observation group were significantly shorter than the control group （ t = 19.408, t =5.253, P = 0.000, P =0.000）,while in the re-bleeding rate,the difference between the two groups was not statistically significant （ t = 0.209, P = 0.648）. The patients of the observation group got a total effective rate of 91.7%,which was significantly better than the 76.7% of the control group （χ 2 = 5.065, P = 0.024 ）.The CRP,NSE and NTF-α levels of the two groups were all significantly improved than before （ t = 29.153, t =20.936, t =42.223, t =20.712, t =15.783, t =22.046, P = 0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000）,and the patients of the observation group got more significant improvement （ t = 7.561, t =8.894, t =13.573, P = 0.000, P =0.000, P =0.000）. The NT-proBNP,GM CSF and HMGB 1 levels of the two gro

关 键 词：高血压 脑出血 微创钻孔引流术 炎性介质 神经功能 老年人 

分 类 号：R651.12[医药卫生—外科学]