立体定向引导神经内镜血肿清除术联合早期系统康复训练治疗基底核区高血压脑出血的临床观察  

Clinical effects of stereotactic-guided endoscopic hematoma removal combined with early systematic rehabilitation training on hypertensive intracerebral hemorrhage in the basal ganglia

作　　者：邹晓燕 仲晓军 Xiaoyan Zou;Xiaojun Zhong(School of Nursing,Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,Zhejiang Province,China;Department of Neurosurgery,Zhejiang Veteran Hospital,Jiaxing 314000,Zhejiang Province,China)

机构地区：[1]浙江中医药大学护理学院,杭州310053 [2]浙江省荣军医院神经外科,嘉兴314000

出　　处：《中国基层医药》2023年第10期1457-1461,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省嘉兴市公益性研究计划(2019AD32216)。

摘　　要：目的观察立体定向引导神经内镜血肿清除术联合早期系统康复训练治疗基底核区高血压脑出血的临床疗效。方法选取2019年6月至2021年12月浙江省荣军医院收治的基底核区高血压脑出血患者130例为研究对象,采用随机对照研究方法,按照随机数字表法分为对照组和研究组,每组65例。对照组实施微创血肿穿刺引流术,研究组实施立体定向引导神经内镜血肿清除术,术后均实施早期系统康复训练,记录手术指标,比较两组术后血清炎症及应激因子水平变化,观察两组脑出血复发、死亡、并发症发生情况及预后。结果研究组手术耗时[(85.39±5.24)min]显著长于对照组[(64.17±4.31)min],血肿清除率[(94.66±5.18)%]显著高于对照组[(76.82±5.39)%](t=-14.56、-17.63,均P<0.001)。研究组术后24 h血清肿瘤坏死因子α[(68.29±5.36)ng/L]、白细胞介素1[(237.62±13.87)ng/L]、去甲肾上腺素[(75.39±5.82)μg/L]和氢化可的松[(30.96±2.97)μg/L]水平均显著低于对照组[(74.61±5.62)ng/L、(295.47±14.69)ng/L、(91.62±6.41)μg/L、(38.25±3.16)μg/L](t=7.95、18.42、16.84、11.75,均P<0.001)。两组术后6个月内病死率比较,差异无统计学意义(P>0.05),而研究组脑出血复发率[1.54%(1/65)]和并发症总体发生率[10.77%(7/65)]均显著低于对照组[12.31%(8/65)、27.69%(18/65)](χ^(2)=4.30、5.99,均P<0.05);研究组术后6个月预后总体优良率[86.15%(56/65)]显著高于对照组[67.69%(44/65)](χ^(2)=6.24,P<0.05)。结论较微创血肿穿刺引流术,立体定向引导神经内镜血肿清除术耗时更长,但可有效提高基底核区高血压脑出血血肿清除率,缓解应激及炎性反应,且联合早期系统化康复训练,有助于降低脑出血复发和并发症风险,改善预后。Objective To investigate the clinical effects of stereotactic-guided endoscopic hematoma removal combined with early systematic rehabilitation training on hypertensive intracerebral hemorrhage in the basal ganglia.Methods A total of 130 patients with hypertensive intracerebral hemorrhage in the basal nucleus who received treatment in Zhejiang Veteran Hospital from June 2019 to December 2021 were included in this randomized control study.They were randomly divided into a control group and a study group(n=65 per group).The control group received minimally invasive hematoma puncture.The study group received stereotactic-guided neuroendoscopic hematoma removal.After surgery,early systematic rehabilitation training was carried out,and surgical indicators were recorded.The levels of serum inflammatory factors and stress factors were determined.The recurrence,death,and complications as well as prognosis of cerebral hemorrhage were recorded in each group.Results The operative time in the study group was(85.39±5.24)minutes,which was significantly longer than(64.17±4.31)minutes in the control group(t=-14.56,P<0.001).Hematoma clearance rate in the study group was(94.66±5.18)%,which was significantly higher than(76.82±5.39)%in the control group(t=-17.63,P<0.001).At 24 hours after surgery,tumor necrosis factor-α,interleukin-1,norepinephrine,and hydrocortisone levels in the study group were(68.29±5.36)ng/L,(237.62±13.87)ng/L,(75.39±5.82)μg/L,and(30.96±2.97)μg/L,respectively,which were significantly lower than(74.61±5.62)ng/L,(295.47±14.69)ng/L,(91.62±6.41)μg/L,and(38.25±3.16)μg/L in the control group(t=7.95,18.42,16.84,11.75,all P<0.001).There was no significant difference in the 6-month mortality rate between the two groups(P>0.05).The recurrence rate of cerebral hemorrhage and the overall incidence of complications in the study group were(1.54%(1/65)and10.77%(7/65))in the study group,respectively,which were significantly lower than 12.31%(8/65)and 27.69%(18/65)in the control group(χ^(2)=4.30,5.99,both P<0.0

关 键 词：颅内出血 高血压性 血肿 神经内窥镜 颅骨切开术 穿刺术 引流术 影像引导 炎症介导素类 康复 复发 手术后并发症 

分 类 号：R651.1[医药卫生—外科学]