微创穿刺引流联合吡拉西坦、乌拉地尔治疗基底节区高血压性脑出血的临床研究  

Clinical study of minimally invasive puncture and drainage combined with piracetam and urapidil in the treatment of hypertensive intracerebral hemorrhage in basal ganglia

作　　者：运陌[1] 李茂芳[2] 王浩[1] 刘东远[1] Yun Mo;Li Maofang;Wang Hao;Liu Dongyuan(Department of Neurosurgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101199,China;Department of Neurosurgery,Liaoyang Central Hospital,China Medical University,Beijing 111010,China)

机构地区：[1]首都医科大学附属北京潞河医院神经外科,北京101199 [2]中国医科大学辽阳中心医院神经外科,北京111010

出　　处：《中华脑科疾病与康复杂志（电子版）》2023年第5期278-285,共8页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：首都卫生发展科研专项基金(2019-4027-06)。

摘　　要：目的探讨微创穿刺引流术联合吡拉西坦和乌拉地尔治疗基底节区高血压性脑出血(HICH)的临床疗效及对患者血清脑损伤标志物、基质金属蛋白酶(MMPs)、白细胞介素-1β(IL-1β)和高迁移率族蛋白B1(HMGB1)水平的影响。方法选择首都医科大学附属北京潞河医院神经外科自2019年1月至2021年12月收治的86例基底节区HICH患者为研究对象,按照随机数字表法分为对照组和观察组,每组43例。对照组给予微创穿刺引流术联合乌拉地尔治疗,观察组在对照组的基础上加用吡拉西坦治疗,连续治疗14 d后比较2组患者的临床疗效。采用美国国立卫生研究院卒中量表(NIHSS)、GCS评分、简易精神状态检查(MMSE)评分评价2组患者治疗前后的神经功能状况、意识状态及认知功能状态。采用酶联免疫法检测2组患者治疗前后的血清脑损伤标志物[神经胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、S100β蛋白]、MMPs(MMP-2、MMP-3、MMP-9)、IL-1β和HMGB1水平。记录2组患者的药物不良反应情况。结果观察组的总有效率[90.70%(39/43)]高于对照组[74.42%(32/43)],差异有统计学意义(P<0.05)。2组患者治疗后的NIHSS评分及血清NSE、GFAP、S100β蛋白、MMP-2、MMP-3、MMP-9、IL-1β、HMGB1水平均显著低于治疗前,GCS、MMSE评分均显著高于治疗前,且观察组较对照组变化更显著,差异均有统计学意义(P<0.05)。所有患者均未发生明显药物不良反应。结论微创穿刺引流术联合吡拉西坦及乌拉地尔治疗基底节区HICH能安全有效地降低患者血清脑损伤标志物、MMPs、IL-1β和HMGB1水平,有助于缓解机体炎症反应,减轻神经功能缺损。Objective To investigate the clinical efficacy of minimally invasive puncture and drainage combined with pilacetan and urapidil in the treatment of hypertensive intracerebral hemorrhage(HICH)in the basal ganglia and its effects on the levels of serum markers of brain injury,matrix metalloproteinases(MMPs),interleukin-1β(IL-1β)and high mobility group protein B1(HMGB1).Methods Eighty-six patients with HICH in basal ganglia region admitted to the Neurosurgery Department of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2019 to December 2021 were randomly divided into a control group and an observation group,with 43 patients in each group.The control group was treated with minimally invasive puncture and drainage combined with urapidil,and the observation group was treated with piracetam based on the control group.After 14 d of continuous treatment,the clinical efficacy of the two groups was compared.The National Institutes of Health stroke scale(NIHSS)score was used to evaluate the neurological function of the subjects before and after treatment,GCS score was used to evaluate the consciousness status of the subjects,and mini-mental state examination(MMSE)was used to evaluate the cognitive function of the patients.Serum brain injury markers[GFAP,neuron-specific enolase(NSE),S100β],MMPs(MMP-2,MMP-3,MMP-9),IL-1βand HMGB1 were detected by enzyme-linked immunoassay before and after treatment.The adverse drug reactions of the two groups were recorded.Results The total effective rate of the observation group was 90.70%(39/43),which was significantly higher than that of the control group[74.42%(32/43)](P<0.05).After treatment,NIHSS score and levels of serum NSE,GFAP,S100βprotein,MMP-2,MMP-3,MMP-9,IL-1βand HMGB1 were significantly lower than before treatment,and GCS and MMSE scores were significantly higher than before treatment,and the changes were more significant in observation group(P<0.05).There was no obvious drug side reaction in all subjects.Conclusion Minimally invasive puncture an

关 键 词：微创穿刺引流术 吡拉西坦 乌拉地尔 高血压性脑出血 脑损伤标志物 基质金属蛋白酶 

分 类 号：R651.1[医药卫生—外科学]