脑室与腰大池序贯引流手术治疗脑出血并破入脑室的效果及其对神经损伤的影响  

Study on the Therapeutic Effect of Sequential Drainage of the Ventricles and Lumbar Cisterns in the Treatment of Cerebral Hemorrhage with Rupture into the Ventricles and Its Impact on Nerve Injury

作　　者：赖余柱 廖书优 徐尉升 唐冠阳 钟杰 廖圣炜 LAI Yuzhu;LIAO Shuyou;XU Weisheng;TANG Guanyang;ZHONG Jie;LIAO Shengwei(Longnan First People's Hospital,Jiangxi Province,Longnan 341700,China)

机构地区：[1]江西省龙南市第一人民医院,江西龙南341700

出　　处：《中国医学创新》2023年第19期6-10,共5页Medical Innovation of China

基　　金：赣州市指导性科技计划项目(20222ZDX8307)。

摘　　要：目的:探讨脑室与腰大池序贯引流手术治疗脑出血并破入脑室的效果及其对神经损伤的影响。方法:选取2020年6月-2022年6月龙南市第一人民医院收治的80例脑出血并破入脑室患者,按随机数字表法分为两组,各40例。对照组予以脑室外引流术治疗,观察组予以脑室与腰大池序贯引流术治疗,均持续引流14 d,并随访6个月。比较两组血肿清除率、血清神经损伤指标、格拉斯哥预后评分(Glasgow outcome scale,GOS)、日常生活能力、生活质量、颅内感染率、脑积水率。结果:观察组术后1、2、3周血肿清除率为(85.63±5.82)%、(93.82±3.25)%、(98.36±0.55)%,均高于对照组的(80.36±5.39)%、(90.14±4.25)%、(95.41±0.52)%,差异均有统计学意义(P<0.05);观察组术后2周神经元特异性烯醇化酶(neuron-specific enolase,NSE)、胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、中枢神经特异蛋白(central nervous system specific protein,S100β)水平为(7.42±1.13)、(0.35±0.06)、(0.82±0.12)μg/L,均低于对照组的(10.35±1.24)、(0.44±0.08)、(1.05±0.16)μg/L,差异均有统计学意义(P<0.05);观察组术后GOS评分、Barthel指数(Barthelindex,BI)为(4.62±0.22)、(85.24±6.39)分,均高于对照组的(4.05±0.28)、(80.12±6.25)分,差异均有统计学意义(P<0.05);观察组术后生理、心理、社会及环境领域评分为(89.39±6.35)、(86.51±5.42)、(90.41±4.58)、(91.04±4.25)分,均高于对照组的(81.27±6.21)、(80.33±5.27)、(84.05±6.23)、(84.36±5.21)分,差异均有统计学意义(P<0.05);观察组颅内感染率、脑积水率均低于对照组,差异均有统计学意义(P<0.05)。结论:脑室与腰大池序贯引流手术可增强脑出血并破入脑室治疗效果,提高血肿清除率,加快NSE、GFAP、S100β水平复常,降低颅内感染及脑积水风险,改善患者日常生活能力及生活质量。Objective:To explore the efficacy of sequential drainage surgery between the ventricles and lumbar cistern in the treatment of cerebral hemorrhage with rupture into the ventricles and its impact on nerve injury.Method:A total of 80 patients with cerebral hemorrhage and ventricular rupture admitted to Longnan First People's Hospital from June 2020 to June 2022 were selected and divided into two groups according to the random number table method,with 40 patients in each group.The control group received external ventricular drainage treatment,while the observation group received sequential ventricular and lumbar cistern drainage treatment,both of which lasted for 14 days and were followed up for 6 months.Hematoma clearance rate,serum nerve injury index,Glasgow outcome scale(GOS),daily living ability,quality of life,intracranial infection rate and hydrocephalus rate were compared between the two groups.Result:The hematoma clearance rates in the observation group at 1 week,2 and 3 weeks after surgery were(85.63±5.82)%,(93.82±3.25)%and(98.36±0.55)%,which were higher than(80.36±5.39)%,(90.14±4.25)%and(95.41±0.52)%in the control group,with statistical significance(P<0.05).The levels of neuron-specific enolase(NSE),glial fibrillary acidic protein(GFAP),central nervous system specific protein(S100β)in the observation group at 2 weeks after operation were(7.42±1.13),(0.35±0.06),(0.82±0.12)μg/L,lower than(10.35±1.24),(0.44±0.08),(1.05±0.16)μg/L in the control group,the differences were statistically significant(P<0.05).The postoperative GOS score and BI of the observation group were(4.62±0.22)and(85.24±6.39)points,which were higher than(4.05±0.28)and(80.12±6.25)points in the control group,the differences were statistically significant(P<0.05).The postoperative physiological,psychological,social,and environmental scores in the observation group were(89.39±6.35),(86.51±5.42),(90.41±4.58)and(91.04±4.25)points,which were higher than(81.27±6.21),(80.33±5.27),(84.05±6.23)and(84.36±5.21)points in the cont

关 键 词：脑出血 脑室引流 腰大池引流 序贯引流 神经损伤 

分 类 号：R651.12[医药卫生—外科学]