神经内镜下脑内血肿清除术治疗高血压相关脑出血的效果及预后影响因素分析  

Efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage

作　　者：张立[1] 刘惠祥[1] 马超[2] 王中[2] 叶经纬 ZHANG Li;LIU Huixiang;MA Chao;WANG Zhong;YE Jingwei(Department of Neurosurgery,the Affiliated Zhangjiagang Hospital of Soochow University,Zhangjiagang 215600,P.R.China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,P.R.China)

机构地区：[1]苏州大学附属张家港医院神经外科,江苏张家港215600 [2]苏州大学附属第一医院神经外科,江苏张家港215600

出　　处：《中国循证医学杂志》2020年第12期1379-1384,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:81571115)。

摘　　要：目的探讨神经内镜下脑内血肿清除术治疗高血压相关脑出血(HICH)的效果并分析影响预后的相关因素。方法选取2015年10月~2019年5月我院收治的HICH患者122例,按不同手术方式分为两组:试验组62例,采取神经内镜下脑内血肿清除术;对照组60例,采取传统开颅脑内血肿清除术。比较两组患者手术指标、术后恢复情况、血清内皮素、IL-6、CRP水平及术后并发症发生率。采用多因素logistic回归分析影响神经内镜下脑内血肿清除术患者预后的相关因素。结果试验组在手术时间、术中出血量、血肿清除率、ICU治疗时间、术后7天脑水肿体积、颅内压水平、NIHSS评分及ADL评分方面均优于对照组;试验组血清内皮素、IL-6及CRP水平低于对照组;试验组术后并发症发生率低于对照组。单因素分析结果显示,神经内镜下脑内血肿清除术患者预后与高血压病史、术前GCS评分、出血量及是否破入脑室具有明显相关性(P<0.05),与患者年龄、性别及出血部位无明显相关性(P>0.05)。多因素logistic回归分析结果显示,高血压病史≥10年、出血量≥50 mL、破入脑室及术前GCS评分是影响神经内镜下脑内血肿清除术患者预后的危险因素。结论与传统开颅脑内血肿清除术相比,神经内镜下脑内血肿清除术治疗HICH具有疗效好、术后并发症发生率低等优点。高血压病史≥10年、出血量≥50 mL、破入脑室及术前GCS评分可能是影响神经内镜下脑内血肿清除术患者预后的危险因素。Objectives To explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.Methods A total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group(n=62)and control group(n=60).The experimental group was treated with endoscopic intracerebral hematoma removal,while the control group was treated with traditional craniotomy.The operative indexes,postoperative recovery,serum endothelin,IL-6,CRP levels and the incidence of postoperative complications were observed and compared between the two groups,and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.Results The operation time,intraoperative blood loss,hematoma clearance rate,ICU treatment time,the volume of brain edema 7 days after operation,the postoperative intracranial pressure,NIHSS score and ADL score in experimental group were significantly superior to those in control group.The levels of serum endothelin,IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation.The incidence of complications in the experimental group was lower than that in control group.Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension,preoperative GCS score,the amount of bleeding and whether been broken into the ventricle(P<0.05),but not with age,sex and location of hemorrhage(P>0.05).Multivariate logistic regression analysis showed that the history of hypertension above 10 years,blood loss above 50 mL,intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.Conclusions Compared with traditional craniotomy,neur

关 键 词：神经内镜下脑内血肿清除术 开颅脑内血肿清除术 高血压相关脑出血 疗效 预后因素 

分 类 号：R651.1[医药卫生—外科学]