不同手术时机小骨窗微创血肿清除术对高血压脑出血患者炎症因子、预后及血清Ang-1、ET、AVP水平的影响  

Effects of Minimally Invasive Hematoma Evacuation with Small Bone Window at Different Operation Time on Inflammatory Factors,Prognosis and Serum Levels of Ang-1,ET and AVP in Patients with Hypertensive Intracerebral Hemorrhage

作　　者：邵政 柳泽彬 肖铮铮[1] 李丽[2] 范波[1] SHAO Zheng;LIU Ze-bin;XIAO Zheng-zheng;LI Li;FAN Bo(I Department of Neurosurgery,The First Affiliated Hospital of Henan University of Science and Technology/School of Clinical Medicine,Henan University of Science and Technology,Luoyang,Henan,471003,China;Department of Internal Neurology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,450052,China)

机构地区：[1]河南科技大学第一附属医院/河南科技大学临床医学院神经外科,河南洛阳471003 [2]郑州大学第一附属医院神经内科,河南郑州450052

出　　处：《现代生物医学进展》2021年第20期3979-3983,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(U1404822)。

摘　　要：目的:探讨不同手术时机小骨窗微创血肿清除术对高血压脑出血(HICH)患者炎症因子、预后及血清血管生成素-1(Ang-1)、内皮素(ET)、血管升压素(AVP)水平的影响。方法:选取2018年1月~2019年12月期间我院收治的130例HICH患者,根据手术时机的不同分为早期组(n=64,发病6~24 h内进行手术)和超早期组(n=66,发病6 h内进行手术),对比两组围术期指标、炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]水平、预后、血清Ang-1、ET、AVP水平、改良Barthel指数(BI)、美国国立卫生研究院卒中量表(NIHSS)评分、并发症发生情况。结果:超早期组住院时间短于早期组,术中出血量少于早期组(P<0.05),两组血肿清除率、手术时间对比无差异(P>0.05)。术后7 d,早期组、超早期组IL-6、TNF-α、hs-CRP、Ang-1、ET、AVP、NIHSS评分均较术前下降,且超早期组低于早期组(P<0.05)。术后7 d,早期组、超早期组BI评分较术前升高,且超早期组高于早期组(P<0.05)。两组并发症发生率比较无差异(P>0.05),超早期组生存率高于早期组(P<0.05)。结论:对HICH患者发病6 h内进行小骨窗微创血肿清除术,可有效减轻手术创伤,改善脑组织缺血状态,促进生活自理能力和神经功能的恢复,降低血清炎症因子水平,改善患者预后,且安全性较好。Objective:To investigate the effects of minimally invasive hematoma evacuation with small bone window at different operation time on inflammatory factors,prognosis and serum levels of angiopoietin-1(Ang-1),endothelin(ET)and vasopressin(AVP)in patients with hypertensive intracerebral hemorrhage(HICH).Methods:From January 2018 to December 2019,130 patients with HICH in our hospital were selected,and divided into early group(n=64,operation within 6~24 hours after onset)and super early group(n=66,operation within 6 hours after onset)according to different operation time.Perioperative indexes,inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high sensitivity C-reactive protein(hs-CRP)]levels,prognosis,serum Ang-1,ET,AVP levels,modified Barthel Index(BI),National Institutes of Health Stroke Scale(NIHSS)score,occurrence of complications were compared between the two groups.Results:The hospitalization time of super early group was shorter than that of early group,and intraoperative blood loss was less than that of early group(P<0.05).There was no difference in hematoma clearance rate and operation time between the two groups(P>0.05).7d after operation,the IL-6,TNF-α,hs-CRP,Ang-1,ET,AVP and NIHSS score of early group and super early group were decreased compared with those before operation,and those of super early group were lower than those of early group(P<0.05).7 d after operation,the BI score of early group and super early group was increased compared with that before operation,and that of super early group was higher than that of early group(P<0.05).There was no difference in the incidence of complications between the two groups(P>0.05).The survival rate of the super early group was higher than that of the early group(P<0.05).Conclusion:Minimally invasive hematoma evacuation with small bone window within 6 hours after onset of HICH can effectively reduce surgical trauma and improve the ischemic state of brain tissue,promote the recovery of self-help ability and neurological function,reduce th

关 键 词：超早期 早期 小骨窗微创血肿清除术 高血压脑出血 炎症因子 预后 血管生成素-1 内皮素 血管升压素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]