微创穿刺引流联合开颅血肿清除术对高血压脑出血合并脑疝患者神经功能、炎症反应及脑部血流的影响  

Effects of Minimally Invasive Puncture Drainage Combined with Craniotomy Hematoma Clearance on Neurological Function,Inflammatory Reaction and Cerebral Blood Flow in Patients with Hypertensive Intracerebral Hemorrhage and Cerebral Hernia

作　　者：买买江·阿不力孜[1] 依马木·依达依吐拉[1] 向兴刚[1] 李大志[1] 张永辉[1] 林琳[1] Maimaijiang·abulizi;Yimamu·Yida yitula;XIANG Xing-gang;LI Da-zhi;ZHANG Yong-hui;LIN Lin(Department of Neurosurgery,Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University,Urumqi,Xinjiang,830000,China)

机构地区：[1]新疆医科大学附属中医医院神经外科,新疆乌鲁木齐830000

出　　处：《现代生物医学进展》2021年第15期2906-2910,共5页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区攻关项目(201528332986)。

摘　　要：目的:探讨开颅血肿清除术联合微创穿刺引流对高血压脑出血(HICH)合并脑疝患者神经功能、炎症反应及脑部血流的影响。方法:回顾性选择2014年4月~2019年11月期间我院收治的HICH合并脑疝患者80例,按照手术方式的不同分为A组(n=38,行开颅血肿清除术)和B组(n=42,行微创穿刺引流联合开颅血肿清除术),对比两组疗效、神经功能、炎症反应、脑部血流及预后情况。结果:B组的总有效率为92.86%(39/42),高于A组的76.32%(29/38),差异有统计学意义(P<0.05)。两组术后7 d血清神经元特异性烯醇化酶(NSE)、S100β蛋白水平以及术后3个月美国国立卫生研究院卒中量表(NIHSS)评分均较术前降低,且B组低于A组(P<0.05)。两组术后7 d血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏-C反应蛋白(hs-CRP)均较术前降低,且B组低于A组(P<0.05)。两组术后1个月、术后3个月大脑中动脉平均流速(Vm)均较术前增加,且B组高于A组(P<0.05);两组术后1个月、术后3个月大脑中动脉搏动指数(PI)较术前降低,且B组低于A组(P<0.05)。两组预后良好率无差异(P>0.05)。结论:与开颅血肿清除术相比,开颅血肿清除术联合微创穿刺引流治疗HICH合并脑疝患者可有效恢复患者脑部血流速度,降低炎症反应,有利于患者神经功能的恢复。Objective:To investigate the effects of minimally invasive puncture drainage combined with craniotomy hematoma clearance on neurological function,inflammatory reaction and cerebral blood flow in patients with hypertensive intracerebral hemorrhage(HICH)and cerebral hernia.Methods:80 patients with HICH and cerebral hernia who were admitted in our hospital from April 2014 to November 2019 were retrospectively selected,they were divided into Group A(n=38,underwent craniotomy hematoma clearance)and group B(n=42,underwent minimally invasive puncture drainage combined with craniotomy hematoma clearance)according to the different surgical methods,the curative effect,neurological function,inflammatory reaction,cerebral blood flow and prognosis were compared between the two groups.Results:The total effective rate of group B was 92.86%(39/42),which was higher than 76.32%(29/38)of group A the difference was statistically significant(P<0.05).The serum neuron specific enolase(NSE),S100βprotein at 7 d after operation and national institutes of health stroke scale(NIHSS)scores at 3 months after operation in the two groups were lower than those of before operation,and group B was lower than group A(P<0.05).The levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high sensitivity C-reactive protein(hs-CRP)in the two groups at 7 d after operation were lower than those of before operation,and group B was lower than group A(P<0.05).The mean velocity of middle cerebral artery(Vm)at 1 month after operationin,3 months after operation in two groups were higher than those of before operation,and group B was higher than group A(P<0.05).Pulsatility index of middle cerebral artery(PI)at 1 month after operation,3 months after operation in two groups were lower than those of before operation(P<0.05),and group B was lower than group A(P<0.05).There was no significant difference in the good prognosis rate between the two groups(P>0.05).Conclusion:Compared with craniotomy hematoma clearance,craniotomy hematoma removal combined

关 键 词：微创穿刺引流 开颅血肿清除术 高血压脑出血 脑疝 神经功能 炎症反应 脑部血流 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]