基于螺旋CT引导的钻孔抽吸术对基底节区高血压脑出血患者血肿清除及血清炎性因子水平的影响  

The effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage

作　　者：解锋 杨朋 Xie Feng;Yang Peng(Department of Neurosurgery,Lanling County People′s Hospital,Linyi 277799,China)

机构地区：[1]兰陵县人民医院神经外科,临沂277799

出　　处：《中国医师进修杂志》2022年第12期1084-1087,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨基于螺旋CT引导的钻孔抽吸术对基底节区高血压脑出血患者血肿清除及血清炎性因子水平的影响。方法选择2017年5月至2020年2月兰陵县人民医院收治的112例基底节区高血压脑出血患者为研究对象,其中采用传统开颅手术56例(开颅组);术前使用螺旋CT定位血肿范围,依据扫描结果定位穿刺点进行钻孔抽吸引流56例(抽吸组)。比较两组患者的手术情况、治疗前后血肿体积变化,计算两组血肿清除率;比较两组治疗前及治疗1个月后血清神经元特异烯醇化酶(NSE)、S100B蛋白、白细胞介素(IL)-17、IL-1β和C-反应蛋白(CRP)水平变化;比较两组治疗前及治疗3个月后美国国立卫生研究院卒中量表(NIHSS)评分及Barthel指数评定量表(BI)评分。结果抽吸组手术时间、术中出血量、术后引流量均低于开颅组[(1.21±0.28)h比(2.43±0.37)h、(131.98±39.51)ml比(231.64±47.65)ml、(41.05±5.68)ml比(62.93±7.83)ml],血肿清除率高于开颅组[(89.57±6.15)%比(77.95±5.92)%],差异均有统计学意义(P<0.05)。治疗后1个月,抽吸组S100B、NES、IL-17、IL-1β、CRP水平低于开颅组[(0.49±0.18)μg/L比(0.67±0.24)μg/L、(15.32±1.67)μg/L比(17.61±1.59)μg/L、(147.38±14.86)ng/L比(172.59±12.94)ng/L、(84.17±10.48)ng/L比(107.43±9.35)ng/L、(33.78±4.77)mg/L比(47.01±4.15)mg/L],差异有统计学意义(P<0.05)。治疗后3个月,抽吸组NIHSS评分低于开颅组、Barthel评分高于开颅组[(3.57±2.13)分比(7.83±2.96)分、(84.56±8.16)分比(67.43±6.95)分],差异均有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论对比传统开颅手术,在螺旋CT引导下对于基底节区高血压脑出血进行抽吸引流的方案具有手术时间短、损伤小、减轻炎性反应、改善神经功能更佳的优势。Objective To investigate the effect of drilling and drainage based on spiral CT-guided on hematoma clearance and serum inflammatory factors levels in patients with basal ganglia region hypertensive cerebral hemorrhage.Methods A total of 112 patients with basal ganglia region hypertensive cerebral hemorrhage admitted to Lanling County People′s Hospital from May 2017 to February 2020 were selected as the research objects,and 56 patients performed traditional craniotomy(craniotomy group),and 56 patients used spinal CT to locate the hematoma area and puncture point before the surgery,and performed drilling and drainage according the scanning results(drilling group).The operation conditions,hematoma volume changes and hematoma clearance rate in two groups were compared.The levels of neuron-specific enolase(NSE),specific protein S100B,interleukin(IL)-17,IL-1βand C-reactive protein(CRP)in two groups before and after the treatment for 1 month were compared.The scores of National Institute of Health Stroke Scale(NIHSS)and Barthel Index Scale(BI)in two groups before and after the treatment for 3 months were compared.Results The operative time,intraoperative blood loss,postoperative drainage volume in the drilling group were lower than those in the craniotomy group:(1.21±0.28)h vs.(2.43±0.37)h,(131.98±39.51)ml vs.(231.64±47.65)ml,(41.05±5.68)ml vs.(62.93±7.83)ml;the hematoma clearance rate in the drilling group was higher than that in the craniotomy group:(89.57±6.15)%vs.(77.95±5.92)%,there were statistical differences(P<0.05).After treatment for 1 month,the levels of S100B,NES,IL-17,IL-1β,CRP in the drilling group were lower than those in the craniotomy group:(0.49±0.18)μg/L vs.(0.67±0.24)μg/L,(15.32±1.67)μg/L vs.(17.61±1.59)μg/L,(147.38±14.86)ng/L vs.(172.59±12.94)ng/L,(84.17±10.48)ng/L vs.(107.43±9.35)ng/L,(33.78±4.77)mg/L vs.(47.01±4.15)mg/L,there were statistical differences(P<0.05).After treatment for 3 months,the scores of NIHSS in the drilling group was lower than that in the craniotomy gro

关 键 词：颅内出血 高血压性 体层摄影术 X线计算机 定位 抽吸引流术 基底节区 

分 类 号：R651.1[医药卫生—外科学]