导航血肿钻孔引流术与骨窗开颅血肿清除术对高血压脑出血患者神经功能和炎性指标的影响  

Effects of trepanation and drainage of navigational hematoma and removal of hematoma by bone window craniotomy on neurological function and inflammatory indexes in patients with hypertensive cerebral hemorrhage

作　　者：韩刚 王载忠 张磊[2] 杨扬 Han Gang;Wang Zaizhong;Zhang Lei;Yang Yang(Department of Neurology,Zhumadian Central Hospital,Zhumadian 463000,China;Intensive Care Unit,Department of Neurosurgery,Hospital of Cerebrovascular Disease,Henan People’s Hospital,Zhengzhou 450000,China;Digital Medicine Laboratory,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]黄淮学院附属驻马店市中心医院神经外一科,驻马店463000 [2]河南省人民医院脑血管病医院神经外科重症监护室,郑州450000 [3]黄淮学院附属驻马店市中心医院数字医学实验室,驻马店463000

出　　处：《中华实验外科杂志》2024年第6期1299-1302,共4页Chinese Journal of Experimental Surgery

基　　金：驻马店市重大专项课题(ZMDSZDZX2023003)。

摘　　要：目的探讨导航血肿钻孔引流术与骨窗开颅血肿清除术对高血压脑出血患者神经功能和炎性指标的影响。方法选取2020年6月到2023年1月驻马店市中心医院收治的62例高血压脑出血患者作为研究对象,根据患者接受治疗的方式,分为导航血肿钻孔引流术组和骨窗开颅血肿清除术组,每组31例。导航血肿钻孔引流术组患者接受导航血肿钻孔引流术,和骨窗开颅血肿清除术组患者接受骨窗开颅血肿清除术。采用美国国立卫生研究院卒中量表分析患者神经功能;采用蒙特利尔认知评估量表分析两组患者认知能力;采用酶联免疫吸附实验(ELISA)分析白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)和降钙素原(PCT)水平。组间计量数据比较采用t检验。结果导航血肿钻孔引流术组患者手术时间、术中出血量、脑脊液恢复时间、置管时间[(1.78±0.37)h、(48.71±11.92)ml、(8.23±1.33)d、(2.22±0.92)d]低于骨窗开颅血肿清除术组患者[(5.05±1.22)h、(213.84±45.34)ml、(14.03±2.27)d、(4.58±1.26)d],差异有统计学意义(t=14.290、19.610、12.270、8.470,P<0.05)。导航血肿钻孔引流术组患者血肿清除率[(91.29±4.26)%]高于骨窗开颅血肿清除术组患者[(76.42±10.47)%],差异有统计学意义(t=7.332,P<0.05)。导航血肿钻孔引流术组术后7 d神经功能评分(12.90±2.59)低于骨窗开颅血肿清除术组神经功能评分(20.35±2.65),差异有统计学意义(t=11.220,P<0.05)。骨窗开颅血肿清除术组患者7 d认知评分(24.96±2.57)高于骨窗开颅血肿清除术组患者术后7 d认知评分(18.77±2.57),差异有统计学意义(t=9.992,P<0.05)。两组患者炎症指标比较,导航血肿钻孔引流术组患者术后7 d血清TNF-α、IL-6、hs-CRP和PCT[(53.71±19.31)pg/ml、(51.29±12.62)pg/ml、(5.49±0.81)mg/ml、(4.24±0.76)mg/ml]低于骨窗开颅血肿清除术组患者[(79.00±11.33)pg/ml、(83.16±15.09)pg/ml、(8.67±0.92)mg/ml、(6.9Objective To investigate the effects of trepanation and drainage of navigational hematoma and removal of hematoma by bone window craniotomy on neurological function and inflammatory indexes in patients with hypertensive cerebral hemorrhage(HCH).Methods A total of 62 patients with HCH admitted in Zhumadian Central Hospital from June 2020 to January 2023 were selected as the study objects.According to the treatment strategies,the patients were divided into navigation hematoma trepanation and drainage group and bone window craniotomy hematoma removal group,with 31 cases in each group.Patients in the navigational hematoma trepanation and drainage group received navigational hematoma trepanation and drainage,and those in the bone window craniotomy hematoma removal group received bone window craniotomy hematoma removal.The neurological function of the patients was analyzed using the National Institute of Health stroke scale(NIHSS).Montreal Cognitive Assessment(MoCA)was used to analyze the cognitive ability of the two groups.Enzyme-linked immunosorbent assay(ELISA)was used to analyze interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP)and procalcitonin(PCT)levels.T test was used to compare measurement data between groups.Results The operative time,intraoperative blood loss,cerebrospinal fluid recovery time,catheterization time in navigation hematoma trepanation and drainage group[(1.78±0.37)h,(48.71±11.92)ml,(8.23±1.33)d,(2.22±0.92)d]were significantly reduced as compared with those in bone window craniotomy hematomas removal group[(5.05±1.22)h,(213.84±45.34)ml,(14.03±2.27)d,(4.58±1.26)d,t=14.290,19.610,12.270,8.470,P<0.05].The hematoma clearance rate in the navigation hematoma trepanation and drainage group[(91.29±4.26)%]was significantly higher than that in the bone window craniotomy hematomas removal group[(76.42±10.47)%,t=7.332,P<0.05].The neurological function score(12.90±2.59)in the navigation hematoma trepanation and drainage group was significantly lower th

关 键 词：导航血肿钻孔引流术 骨窗开颅血肿清除术 高血压 脑出血 神经功能 

分 类 号：R651.1[医药卫生—外科学]