不同时机微创颅内血肿穿刺引流术对高血压脑出血患者血清神经元特异性烯醇化酶、脑源性神经营养因子和同型半胱氨酸水平的影响  

Influence of minimally invasive intracranial hematoma puncture and drainage at different operation opportunities on serum levels of NSE,BDNF and Hcy in patients with hypertensive intracerebral hemorrhage

作　　者：赵悦 任海军[2] ZHAO Yue;REN Haijun(Department of Neurosurgery,the First People＇s Hospital of Xianyang,Shanxi,Xianyang 712000,China)

机构地区：[1]陕西咸阳市第一人民医院神经外一科,712000 [2]兰州大学第二医院神经外科

出　　处：《临床外科杂志》2018年第9期689-692,共4页Journal of Clinical Surgery

摘　　要：目的探讨不同时机开展微创颅内血肿穿刺引流术治疗高血压脑出血病人(HICH)的疗效及对病人血清神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、同型半胱氨酸(Hcy)水平的影响。方法行微创颅内血肿穿刺引流术治疗的HICH病人200例。根据发病至手术时机分为4组:超早期组(时间<6 h) 23例,早期组(6～12 h) 52例,中期组(时间> 12～24 h) 96例和延期组(时间> 24 h) 29例。比较4组术后再出血率、近期预后,评价美国国立卫生研究院卒中量表(NIHSS)评分,测定血清NSE、BDNF、Hcy水平变化。结果超早期组和早期组的血肿完全清除率、预后良好率均显著高于中期组、延期组(P <0. 05),超早期组再出血率显著高于其余3组(P <0. 05)。术后14天、3个月、6个月,超早期组和早期组的NIHSS评分显著低于中期组、延期组(P <0. 05);超早期组和早期组术后血清NSE、Hcy水平显著低于中期组、延期组,BDNF显著高于中期组、延期组(P <0. 05)。结论微创颅内血肿穿刺引流术治疗HICH最佳手术时间窗为12小时内,在病情允许情况下越早手术临床预后越好,其机制可能与NSE、BDNF及Hcy水平变化有关。Objective To investigate the efficacy of minimally invasive intracranial hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage（ HICH） at different operation opportunities and its influence on the serum levels of neuron-specific enolase（ NSE）,brain-derived neurotrophic factor（ BDNF） and homocysteine（ Hcy）. Methods The clinical data of 200 patients with HICH who treated with minimally invasive intracranial hematoma puncture and drainage were retrospectively analyzed. The patients were divided into four groups according to the time of operation： 23 cases as ultra-early group（ 〈6 h）,52 cases as early group（ 6 - 12 h）,96 cases as mid-term group（ 〉12 - 24 h）and 29 cases as delayed group（〉24 h）. The rate of postoperative rebleeding and the short-term prognosis were compared among the four groups,the scores of National Institutes of Health Stroke Scale（ NIHSS） was evaluated,the changes of serum NSE,BDNF and Hcy levels were determined. Results The complete hematoma clearance rate and good prognosis rate in the ultra-early group and the early group were significantly higher than those in the mid-term group and deferred group（ P〈0. 05）. The rebleeding rate in the ultra-early group was significantly higher than that in the other three groups（ P〈0. 05）. After surgery,the serum levels of NSE and Hcy were significantly lower than the mid-term and delayed groups,while the BDNF was significantly higher than the two groups（ P〈0. 05）. Conclusion The optimal operation window of minimally invasive intracranial hematoma puncture and drainage for HICH is 12 hours after HICH.The earlier operation is more conducive to gain better clinical prognosis and can protect the cerebral nerve function,its mechanism may be related to the regulation of NSE,BDNF and Hcy levels.

关 键 词：高血压脑出血 微创颅内血肿穿刺引流术 神经元特异性烯醇化酶 脑源性神经营养因子 同型半胱氨酸 

分 类 号：R651.1[医药卫生—外科学]