神经内镜和显微镜下微创血肿清除术治疗基底核区脑出血患者的临床价值  

Clinical value of neuroendoscope and microscope minimally invasive hematoma removal in the treatment of patients with intracerebral hemorrhage in the basal nucleus

作　　者：许耀伟 李永明[2] 左敏现 刘琴[3] XU Yao-wei;LI Yong-ming;ZUO Min-xian;LIU Qin(Department of Neurosurgery,Luoyang Hospital of Traditional Chinese Medicine,Luoyang 471000,Henan,CHINA;Department of Neurosurgery,Henan Provincial People's Hospital,Zhengzhou 450000,Henan,CHINA;Outpatient Department,the First People's Hospital of Shangqiu,Shangqiu 476000,Henan,CHINA)

机构地区：[1]洛阳市中医院神经外科,河南洛阳471000 [2]河南省人民医院神经外科,河南郑州450000 [3]商丘市第一人民医院门诊科,河南商丘476000

出　　处：《海南医学》2023年第13期1856-1860,共5页Hainan Medical Journal

基　　金：2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20200930)。

摘　　要：目的比较神经内镜和显微镜下行微创血肿清除术(MIHR)治疗在基底核区脑出血患者中的临床应用效果,为患者手术方式选择提供理论依据。方法选择2020年1月至2022年1月洛阳市中医院收治的78例基底核区脑出血患者为研究对象,按随机数表法分为神经神经内镜组和显微镜组各39例。神经内镜组患者在神经内镜下实施MIHR术,显微镜组患者在显微镜下实施MIHR术。比较两组患者的手术指标,术后并发症,术后3 d、7 d氧化应激指标[谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)、超氧化物歧化酶(SOD)],术后6个月神经功能损伤程度[美国国立卫生院卒中评分量表(NIHSS)],昏迷情况[格拉斯哥昏迷评分量表(GCS)]和预后优良率。结果神经内镜组患者的手术时间、手术切开长度、总住院天数分别为(104.72±22.39)min、(1.89±0.41)cm、(14.38±2.31)d,明显短于显微镜组的(167.45±29.44)min、(2.73±0.52)cm、(16.72±2.37)d,术中总出血量为(74.59±18.47)mL,明显少于显微镜组的(138.62±20.59)mL,血肿清除率为(92.42±3.39%)%,明显高于显微镜组的(89.73±3.56)%,差异均有统计学意义(P<0.05);神经内镜组患者的术后并发症发生率、术后6个月预后优良率分别为10.26%、92.31%,分别与显微镜组的17.95%、76.92%比较差异均无统计学意义(P>0.05);神经内镜组患者术后3 d的SOD、GSH-Px水平分别为(75.83±5.51)U/L、(128.32±20.17)U/mL,术后7 d分别为(85.71±5.59)U/L、(158.49±18.44)U/mL,明显高于显微镜组患者术后3d的(71.58±5.28)U/L、(113.29±20.68)U/mL和术后7 d的(77.93±5.43)U/L、(142.62±19.43)U/mL,MDA水平术后3d、7 d分别为(10.36±1.74)μmol/L、(7.29±1.55)μmol/L,明显低于显微镜组的(11.59±1.71)μmol/L、(8.67±1.68)μmol/L,差异均有统计学意义(P<0.05);术后6个月,神经内镜组患者的NIHSS评分为(11.48±4.64)分,明显低于显微镜组的(16.92±4.76)分,GCS评分为(13.17±1.45)分,明显高于显微镜组的(11.92±1.39)分,差Objective To compare the application effect of neuroendoscope and microscope minimally inva-sive hematoma removal(MIHR)in the treatment of patients with intracerebral hemorrhage in the basal nucleus,and to provide theoretical basis for the selection of surgical methods for patients.Methods Seventy-eight patients with intra-cerebral hemorrhage in the basal nucleus region admitted to Luoyang Hospital of Traditional Chinese Medicine from Jan-uary 2020 to January 2022 were collected as research objects and randomly divided into neuroendoscope group and mi-croscope group according to random number table method,with 39 cases in each group.Patients in the neuroendoscope group received minimally invasive hematoma removal under the neuroendoscope,and those in the microscope group re-ceived minimally invasive hematoma removal under the microscope.The indexes related to operation,postoperative complications,and oxidative stress indexes[glutathione peroxidase(GSH Px),malondialdehyde(MDA),superoxide dis-mutase(SOD)]after 3 days and 7 days of operation,the degree of nerve function damage[national institutes of health stroke table(NIHSS)],coma situation[Glasgow coma scale(GCS)],and the rate of excellent prognosis after 6 months of operation were compared between the two groups.Results The operation time,incision length,and length of hospital stay in the neuroendoscope group were(104.72±22.39)min,(1.89±0.41)cm,(14.38±2.31)d,respectively,which were significantly shorter than(167.45±29.44)min,(2.73±0.52)cm,and(16.7±2.37)d in the microscope group;the intraop-erative bleeding volume was(74.59±18.47)mL,which was significantly less than(138.62±20.59)mL in the micro-scope group;the hematoma clearance rate was(92.42±3.39)%,which was significantly higher than(89.73±3.56)%in the microscope group;the differences were statistically significant(P<0.05).The incidence of complications and the rate of excellent prognosis after 6 months of operation were 10.26%and 92.31%in the neuroendoscope group,which were not significantly different

关 键 词：基底核区脑出血 神经内镜下血肿清除术 显微镜下血肿清除术 血肿清除率 神经功能 

分 类 号：R651.1[医药卫生—外科学]