经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对高血压性基底节区脑出血患者神经功能损伤的影响  

Effect of microsurgery via lateral fissure insular approach and hematoma clearance via frontal lobe approach on neurological damage in patients with hypertensive basal ganglia hemorrhage

作　　者：罗铸[1] 李伦走 黄章峰 李科良 张传东[1] LUO Zhu;LI Lunzou;HUANG Zhangfeng;LI Keliang;ZHANG Chuandong(Hechi People’s Hospital,Hechi 547000,China)

机构地区：[1]河池市人民医院,广西河池547000

出　　处：《中国实用神经疾病杂志》2024年第6期727-731,共5页Chinese Journal of Practical Nervous Diseases

基　　金：广西壮族自治区卫生健康委员会项目(编号:Z20190500)。

摘　　要：目的探讨高血压性基底节区脑出血患者应用经外侧裂-岛叶入路显微手术与经额叶入路血肿清除术对神经功能损伤的影响。方法回顾性分析广西河池市人民医院2019-01—2022-12收治的121例高血压性基底节区脑出血患者的临床资料,分为A组61例(经外侧裂-岛叶入路显微手术)与B组60例(经额叶入路血肿清除术)。比较2组患者神经功能损伤指标水平及其他相关指标。结果2组患者手术时间、住院时间比较无统计学差异(P>0.05);A组术后意识恢复时间(5.11±0.89)h,短于B组的(6.03±0.73)h,术中出血量(37.21±4.27)mL,少于B组的(39.82±4.41)mL,48 h血肿清除率(90.06±3.44)%,大于B组的(88.69±4.02)%,差异均有统计学意义(t=6.178、3.299、2.017,P<0.05);A组临床总有效率98.36%(60/61),高于B组的86.67%(52/60)(χ^(2)=4.460,P=0.035);术后3 d,2组患者S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)水平均较术前下降,且A组低于B组(P<0.05);2组患者术后并发症发生率比较无统计学差异(P>0.05);术后3个月,A组格拉斯哥预后量表(GOS)评分高于B组(P<0.05);2组患者术后6个月GOS评分比较无明显差异(P>0.05)。结论相比于经额叶入路血肿清除术,应用经外侧裂-岛叶入路显微手术可更有效促进高血压性基底节区脑出血患者神经功能损伤恢复,减少术中出血量,提高血肿清除率及临床疗效,且能够显著改善患者近期预后。Objective To compare the effect of microsurgery via the lateral fissure insular approach and hematoma clearance via the frontal lobe approach on nerve damage in patients with hypertensive basal ganglia intracerebral hemorrhage.Methods A retrospective analysis was conducted on the clinical data of 121 patients with hypertensive basal ganglia hemorrhage admitted to Hechi People’s Hospital from January 2019 to December 2022.They were divided into group A(61 cases)with microsurgery via the lateral fissure insular approach and group B(60 cases)with hematoma clearance via the frontal lobe approach.The levels of nerve injury indexes and other related indexes were compared between the two groups.Results There was no significant difference in operation time and hospitalization time between the two groups(P>0.05).The postoperative consciousness recovery time in group A(5.11±0.89)was shorter than that in group B(6.03±0.73),and the intraoperative bleeding volume(37.21±4.27)was less than that in group B(39.82±4.41),and the 48 hour hematoma clearance rate((90.06±3.44)%)was higher than that in group B((88.69±4.02)%),the differences were statistically significant(t=6.178,3.299,2.017,respectively,P<0.05).The total clinical effective rate of group A was 98.36%(60/61),which was higher than 86.67%(52/60)in the group B(χ^(2)=4.460,P=0.035).Three days after surgery,the levels of S-100βprotein,neuron specific enolase(NSE),and glial fibrillary acidic protein(GFAP)in both groups decreased compared to before surgery,and group A was lower than group B(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).At 3 months after surgery,the Glasgow outcome scale(GOS)score in group A was higher than that of group B(P<0.05).There was no significant difference in GOS score between the two groups at 6 months after operation(P>0.05).Conclusion Compared with the frontal lobe approach,the lateral fissure island approach microsurgery can more effectively promote the recovery o

关 键 词：高血压性基底节区脑出血 经额叶入路 经外侧裂-岛叶入路 血肿清除术 神经功能损伤 

分 类 号：R743.34[医药卫生—神经病学与精神病学]