神经内镜微创颅内血肿清除术对脑出血血肿清除率的影响  

Effect of neuroendoscopic minimally invasive intracranial hematoma removal on hematoma clearance rate of intracerebral hemorrhage

作　　者：魏小兵[1] 温一奇 李素美 胡永珍 刘洋[1] 龙青山[1] 黄楚涛 刘惜弟 Wei Xiaobing;Wen Yiqi;Li Sumei;Hu Yongzhen;Liu Yang;Long Qingshan;Huang Chutao;Liu Xidi(Department of Neurosurgery,Huizhou Third People's Hospital,Huizhou 516000,Guangdong)

机构地区：[1]惠州市第三人民医院神经外科,广东惠州516000

出　　处：《现代科学仪器》2021年第6期151-155,共5页Modern Scientific Instruments

基　　金：编号(210421174574600)课题名称:神经内镜微创颅内血肿清除术对幕上高血压脑出血患者血肿清除率及血HMGB-1、MMP-9、GM-CSF表达的影响。

摘　　要：目的:探究神经内镜微创颅内血肿清除术对幕上高血压脑出血(HICH)患者血肿清除率及血高迁移率族蛋白-1(HMGB-1)、基质金属蛋白酶-9(MMP-9)、粒细胞巨噬细胞集落刺激因子(GM-CSF)表达的影响。方法:选取2017年2月~2021年6月我院幕上HICH患者97例,按治疗术式不同分为神经内镜组(n=49)、小骨窗组(n=48),神经内镜组采取神经内镜微创颅内血肿清除术,小骨窗组采取小骨窗血肿清除术。比较2组手术情况、血肿吸收情况、并发症发生率及术前、术后1周血HMGB-1、MMP-9、GM-CSF表达,术后随访6个月,对比2组预后情况及术前、术后6个月神经功能缺损评分(NIHSS)、日常生活能力评分(BI)。结果:(1)手术情况:神经内镜组手术时间、住院时间、术后下床活动时间短于小骨窗组,术中出血量低于小骨窗组(P<0.05);(2)血肿吸收情况:神经内镜组术后血肿量低于小骨窗组,血肿清除率高于小骨窗组(P<0.05);(3)并发症:神经内镜组并发症发生率(6.12%)低于小骨窗组(22.92%,P<0.05);(4)血HMGB-1、MMP-9、GM-CSF表达:术后1周神经内镜组血HMGB-1、MMP-9、GM-CSF表达低于小骨窗组(P<0.05);(5)NIHSS、BI评分:神经内镜组术后6个月NIHSS评分低于小骨窗组,BI评分高于小骨窗组(P<0.05);(6)预后情况:随访6个月,神经内镜组预后优良率(61.22%)高于小骨窗组(39.58%,P<0.05)。结论:神经内镜微创颅内血肿清除术应用于幕上HICH患者,能显著减少术后血肿量,提高血肿清除率,降低炎症反应,缩短术后康复时间,修复神经功能,增强日常生活能力,改善预后,且安全性高。Objective:To investigate the hematoma clearance rate and blood high mobility group protein-1(HMGB-1)and matrix metalloproteinase-9 in patients with supratentorial hypertensive cerebral hemorrhage(HICH)after neuroendoscopic minimally invasive intracranial hematoma evacuation.(MMP-9),the effect of granulocyte macrophage colony-stimulating factor(GM-CSF)expression.Methods:97 patients with HICH on the scene of our hospital from February 2017 to June 2021 were enrolled.They were divided into neuroendoscopy group(n=49)and small bone window group(n=48)according to different treatment procedures.Neuroendoscopy The group underwent neuroendoscopic minimally invasive intracranial hematoma evacuation,and the small bone window group underwent small bone window hematoma removal.The operation of the two groups,the hematoma absorption,the incidence of complications and the expression of HMGB-1,MMP-9 and GM-CSF in the blood before and 1 week after operation were compared.The prognosis and operation of the two groups were compared.Neurological deficit score(NIHSS)and daily living ability score(BI)were 6 months before and after surgery.Results:(1)Surgery:The operation time,hospitalization time,and time of postoperative outpatient activity in the neuroendoscopy group were shorter than those in the small bone window group.The intraoperative blood loss was lower than that in the small bone window group(P<0.05).(2)Hematoma absorption Situation:The amount of hematoma in the neuroendoscopy group was lower than that in the small bone window group,and the hematoma clearance rate was higher than that in the small bone window group(P<0.05).(3)Complications:The incidence of complications in the neuroendoscopic group(6.12%)was lower than that.Small bone window group(22.92%,P<0.05);(4)Blood HMGB-1,MMP-9,GM-CSF expression:HMGB-1,MMP-9,GM-CSF expression in neuroendoscopic group 1 week after operation Below the small bone window group(P<0.05);(5)NIHSS,BI score:the NIHSS score was lower in the neuroendoscopy group than in the small bone window grou

关 键 词：神经内镜微创颅内血肿清除术 高血压脑出血 血肿清除率 高迁移率族蛋白-1 基质金属蛋白酶-9 粒细胞巨噬细胞集落刺激因子 

分 类 号：R65[医药卫生—外科学]