精准定位下内镜手术治疗老年脑出血临床观察  

Clinical observation of endoscopic surgery under precise positioning in the treatment of senile intracerebral hemorrhage

作　　者：田齐 陈熙龙 贾海莉 TIAN Qi;CHEN Xilong;JIA Haili(The First Affiliated Hospital of Hebei North College,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000

出　　处：《中国实用神经疾病杂志》2022年第5期593-598,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省卫生健康委员会科研基金项目(编号:20220598)。

摘　　要：目的 探究精准定位下内镜手术治疗老年脑出血短期预后危险因素及其对炎症反应、应激反应的影响。方法 回顾性连续纳入河北北方学院附属第一医院2017-02—2019-04收治的62例老年脑出血患者,研究组29例和对照组33例,其中研究组应用开源软件辅助神经内镜血肿清除术,对照组应用传统开颅血肿清除术。于术前、术后7 d检测2组患者血肿体积、美国国立卫生研究院卒中量表(NIHSS)评分、炎症反应指标[白细胞介素-8(IL-8)、正五聚蛋白3(PTX3)、血管细胞黏附分子(VCAM1)、核因子-κB(NF-κB)]及应激反应指标[丙二醛(MDA)、过氧化物酶体增殖物激活受体γ(PPARγ)、活性氧(ROS)、缺血修饰清蛋白(IMA)],分析研究组各影响因素和短期预后之间的相关性。结果 术后7 d,研究组与对照组NF-κB、VCAM1、PTX3、IL-8(0.97±0.16 vs 1.59±0.30,40.25±4.51 vs 56.21±6.53,2.80±0.40 vs4.17±0.68,42.20±4.59 vs 65.15±6.57)均出现显著升高,研究组低于对照组(P<0.01)。2组IMA、ROS、PPARγ、MAD(83.08±8.36 vs 97.62±9.36,9.12±1.23 vs 15.92±2.33,2.18±0.45 vs 3.11±0.77,5.90±0.61 vs 9.92±1.03)均显著升高,研究组低于对照组(P<0.01)。2组NIHSS评分、血肿体积(8.96±1.92 vs 12.29±2.35,4.28±0.41 vs 8.91±1.59)均出现显著降低,且研究组低于对照组(P<0.01)。对研究组患者临床资料进行分析发现,血肿未破入脑室、出血量<50 mL、入院GCS评分>5分以及年龄60~69岁的患者预后较好。Logistic回归分析显示,血肿破入脑室、出血量≥50 mL、入院GCS评分<5分以及年龄70~80岁是影响接受精准定位下内镜手术治疗的老年脑出血患者预后的危险因素。结论 精准定位下内镜手术对老年脑出血患者血肿清除程度高,且可有效减轻由手术创伤激发的全身炎症、应激反应,而其影响预后的独立因素包括血肿破入脑室、出血量≥50 mL、入院GCS评分<5分以及年龄70~80岁。Objective To investigate the short-term prognostic risk factors of endoscopic surgery under precise positioning for elderly cerebral hemorrhage and its effects on inflammatory response and stress response.Methods Retrospectively included 62 elderly patients with cerebral hemorrhage admitted from February 2017 to April 2019 in ourHospital,and divided them into a research group(29 cases) and a control group(33 cases) according to the surgical method.Open source software was used to assist neuroendoscopic hematoma removal in research group,and the control group used traditional craniotomy hematoma removal.Before operation and 7 days after operation,the volume of hematoma,NIHSS score,inflammatory response indexes of intergroup-8(IL-8),pentraxin 3(PTX3) were detected),Vascular cell adhesion molecule(VCAM1),nuclear factor-κB(NF-κB)] and stress response indicators [malondialdehyde(MDA),peroxisome proliferator-activated receptor γ(PPARγ),reactive oxygen species(ROS),ischemia modified albumin(IMA)].Analyze the correlation between the influencing factors of the endoscopy group and the short-term prognosis.Results 7 days after operation,NF-κB,VCAM1,PTX3,IL-8 in the study and control groups(0.97±0.16 vs 1.59±0.30,40.25±4.51 vs 56.21±6.53,2.80±0.40 vs4.17±0.68,42.20±4.59 vs 65.15±6.57) were significantly increased,but the study group was lower than the control group(P<0.01);IMA,ROS,PPARγ,MAD in the two groups(83.08±8.36 vs 97.62±9.36,9.12±1.23 vs 15.92±2.33,2.18±0,45 vs 3.11±0.77,5.90±0.61 vs 9.92±1.03) were significantly increased,but the study group was lower than the control group(P<0.01);NIHSS score and Hematoma volume of both groups(8.96±1.92 vs 12.29±2.35,4.28±0.41 vs 8.91±1.59) were significantly reduced,and the study group was lower than the control group(P<0.01);analysis of clinical data of 29 elderly patients with cerebral hemorrhage in the endoscopic group found that the hematoma did not break into the ventricle,patients with bleeding volume <50 mL,admission GCS score> 5,and patients aged

关 键 词：老年脑出血 精准定位下内镜手术 短期预后 危险因素 神经功能 炎症应激反应 

分 类 号：R743.34[医药卫生—神经病学与精神病学]