亚低温联合神经内镜微创手术对老年高血压脑出血患者的影响  

Effect of Mild Hypothermia Combined with Minimally Invasive Neuroendoscopic Surgery on Older Patients with Hypertensive Cerebral Hemorrhage

作　　者：李志强[1] 李剑 梁建锋[1] 朱振云[1] 王小明[2] Li Zhiqiang;Li Jian;Liang Jianfeng;Zhu Zhenyun;Wang Xiaoming(Department of Neurosurgery,the First Hospital of Fangshan District,Beijing 102400;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070)

机构地区：[1]北京市房山区第一医院神经外科,北京102400 [2]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《国际老年医学杂志》2023年第2期200-204,共5页International Journal of Geriatrics

基　　金：首都卫生发展科研专项项目(2019-4021-06)。

摘　　要：目的探讨亚低温联合神经内镜微创手术对老年高血压脑出血患者的影响。方法选取房山区第一医院神经外科2018年5月~2020年5月收治的80例高血压脑出血患者作为研究对象,按照随机数字表法分为两组,各40例。对照组接受开颅血肿清除术,联合组采用亚低温联合神经内镜微创手术治疗。比较两组手术情况[出血量、血肿残余量及血肿清除率]、神经功能[美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷评分(GCS)]、血清白细胞介素1β(IL-1β)、血小板反应蛋白2(TSP2)水平、神经损伤因子水平[心脏型脂肪酸结合蛋白(H-FABP)、B型钠尿肽前体(pro-BNP)、神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)]、预后情况[格拉斯哥预后评分表(GOS)]及并发生发生情况。结果联合组血肿残余量少于对照组,血肿清除率高于对照组,术后6个月NIHSS低于对照组、GCS高于对照组,术后2周的血清IL-1β、TSP2、H-FABP、pro-BNP、NSE、MBP水平低于对照组,预后GOS评分优于对照组,术后并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论亚低温联合神经内镜微创手术可改善高血压脑出血患者的神经功能,降低IL-1β、TSP2表达水平,抑制炎症反应,减轻神经损伤,改善预后,值得临床推广。Objective To investigate the effect of mild hypothermia combined with minimally invasive neuroendoscopic surgery on older patients with hypertensive cerebral hemorrhage.Methods Eighty patients with hypertensive cerebral hemorrhage admitted to the First Hospital of Fangshan District from May 2018 to May 2020 were enrolled in this study.The patients were divided into a control group(40 cases)and a combination group(40 cases)according to the random number table.The control group was treated with craniotomy for hematoma clearance.The combination group was treated with mild hypothermia combined with minimally invasive neuroendoscopic surgery.The following indicators were compared between the two groups:hemorrage volume,residual amount of hematoma,hematoma clearance rate;score of National Institutes of Health Stroke Scale(NIHSS),score of Glasgow coma scale(GCS);levels of interleukin-1β(IL-1β),thrombospondin 2(TSP2),heart-type fatty acid binding proteins(H-FABP),pro-brain natriuretic peptide(pro-BNP),neuron specific enolase(NSE),myelin basic protein(MBP)in serum;score of Glasgow outcome scale(GOS),and incidence of complications.Results Compared with the control group,the combination group had lower residual volume of hematoma,higher clearance rate of hematoma;lower NIHSS score and higher GCS score at 6 months after surgery;lower levels of IL-1β,TSP2,H-FABP,pro-BNP,NSE and MBP at two week after surgery;better GOS score,lower incidence of postoperative complications.The differences were statistically significant between the two groups(P<0.05).Conclusion Mild hypothermia combined with minimally invasive neuroendoscopic surgery can improve the nerve function of patients with hypertensive cerebral hemorrhage,reduce the expression of IL-1βand TSP2,inhibit inflammatory reaction,reduce nerve damage,and improve the prognosis.

关 键 词：亚低温 神经内镜微创手术 高血压脑出血 神经功能 白细胞介素1Β 血小板反应蛋白2 

分 类 号：R651.1[医药卫生—外科学]