经膜髓帆入路手术治疗高血压性脑桥出血的效果及其与患者神经功能预后的关系研究  

Effect of Transtelovelar Approach of Surgery on Hypertensive Pontine Hemorrhage and Its Relationship with Neurological Function Prognosis of the Patients

作　　者：王传宝 刘晶晶 李惊涛[1] 陈琪[1] 刘小印 WANG Chuanbao;LIU Jingjing;LI Jingtao;CHEN Qi;LIU Xiaoyin(Department of Neurosurgery,Hanzhong Central Hospital,Hanzhong 723000,China;Department of Critical Care Medicine,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]陕西省汉中市中心医院神经外科,723000 [2]陕西省汉中市中心医院重症医学科,723000

出　　处：《实用心脑肺血管病杂志》2020年第7期125-128,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：汉中市中心医院院级科研基金中标项目(YK1908)。

摘　　要：目的探讨经膜髓帆入路手术治疗高血压性脑桥出血的效果及其与患者神经功能预后的关系。方法选取2010—2018年汉中市中心医院收治的高血压性脑桥出血患者84例,根据治疗方式不同分为手术组36例和对照组48例;另根据神经功能预后分为预后良好组16例和预后不良组68例。分别比较手术组与对照组、预后良好组与预后不良组患者临床资料;高血压性脑桥出血患者神经功能预后的影响因素分析采用多因素Logistic回归分析。结果手术组患者神经功能预后优于对照组,治疗30 d后血清超敏C反应蛋白(hs-CRP)水平低于对照组(P<0.05)。预后良好组患者入院时收缩压、入院时格拉斯哥昏迷量表(GCS)评分、出血量、瞳孔对光反射消失发生率和大血肿发生率均低于预后不良组,经膜髓帆入路手术治疗率高于预后不良组(P<0.05);多因素Logistic回归分析结果显示,入院时GCS评分>8分〔OR=1.381,95%CI(1.017,1.875)〕是高血压性脑桥出血患者神经功能预后的独立危险因素,而经膜髓帆入路手术治疗〔OR=0.882,95%CI(0.759,0.932)〕是高血压性脑桥出血患者神经功能预后的独立保护因素(P<0.05)。结论采用经膜髓帆入路手术治疗可减轻高血压性脑桥出血患者炎性反应,改善患者神经功能预后,且经膜髓帆入路手术治疗是高血压性脑桥出血患者神经功能预后的独立保护因素。Objective To investigate the effect of transtelovelar approach of surgery on hypertensive pontine hemorrhage and its relationship with neurological function prognosis of the patients.Methods From 2010 to 2018,a total of 84 patients with hypertensive pontine hemorrhage were selected from Hanzhong Central Hospital,which were divieded into the surgery group with 36 cases and the control group with 48 cases according to different treatment methods;and also divided into the good prognosis group with 16 cases and the poor prognosis group with 68 cases according to the prognosis of neurological function.Clinical data were compared between surgery group and control group,good prognosis group and poor prognosis group;multivariate Logistic regression analysis was used to analyse the influencing factors for neurological function prognosis in patients with hypertensive pontine hemorrhage.Results The neurological function prognosis in surgery group was better than that in control group,serum hypersensitive C reactive protein(hs-CRP)level at 30 days after treatment in surgery group was lower than that in control group(P<0.05).Systolic blood pressure at admission,GCS score at admission,bleeding volume and incidence of pupil reflection of light disappearance and large hematoma in good prognosis group were lower than those in poor prognosis group,while transtelovelar approach of surgery rate in good prognosis group was higher than that in poor prognosis group(P<0.05).Multivariate Logistic regression analysis showed that,GCS score at admission>8〔OR=1.381,95%CI(1.152,1.603)〕was independent risk factors for neurological function prognosis in patients with hypertensive pontine hemorrhage,and transtelovelar approach of surgery〔OR=0.882,95%CI(0.759,0.932)〕was an independent protective factor for neurological function prognosis in patients with hypertensive pontine hemorrhage(P<0.05).Conclusion Transtelovelar approach of surgery can reduce the inflammatory response of patients with hypertensive pontine hemorrhage,and improve the

关 键 词：高血压性脑桥出血 经膜髓帆入路 神经功能 超敏C反应蛋白 预后 

分 类 号：R651.12[医药卫生—外科学]