立体定向微创术对老年自发性丘脑出血患者术后再出血及近期预后的影响  

Effect of stereotactic minimally invasive surgery on postoperative rebleeding and recent prognosis in elderly patients with spontaneous thalamic hemorrhage

作　　者：孙会英 冉小平 王维波 邓达 吴波 尹泽钢 SUN Huiying;RAN Xiaoping;WANG Weibo;DENG Da;WU Bo;YIN Zegang(Ziyang Hospital of Traditional Chinese Medicine,Ziyang 641300,China)

机构地区：[1]资阳市中医医院,四川资阳641300

出　　处：《中国实用神经疾病杂志》2024年第9期1146-1151,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省重症医学(国瑞)专项科研课题(编号:18PJ015)。

摘　　要：目的探究立体定向微创术在老年自发性丘脑出血患者治疗中的应用价值。方法选取2020-04—2022-05资阳市中医医院收治的99例自发性丘脑出血患者,随机分为2组,其中对照组患者(n=49)给予药物保守治疗,研究组患者(n=50)给予立体定向微创术治疗。比较2组治疗前后血肿体积、各向异性分数(FA)值、血清炎性因子[C反应蛋白(CRP)、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子α(TNF-α)]、预后相关因子[核因子-κBp65(NF-κB p65)、血小板源性生长因子-D(PDGF-D)、轴突生长抑制因子A(Nogo-A)]水平、神经功能(NIHSS评分)、意识障碍程度(GCS评分)、日常生活能力(MBI评分)、并发症、住院时间,所有患者出院后均随访3个月,统计比较2组预后情况。结果治疗后1、2周研究组血肿体积低于对照组,FA值高于对照组(P<0.05);治疗后1、3个月研究组血清CRP、MMP-9、TNF-α、NF-κB p65、PDGF-D、Nogo-A水平均低于对照组(P<0.05);治疗后1、3个月研究组NIHSS评分低于对照组,GCS、MBI评分均高于对照组(P<0.05);研究组再出血、肺部感染、下肢静脉血栓发生率低于对照组,住院时间短于对照组(P<0.05);研究组预后良好率76.00%高于对照组55.10%(P<0.05)。结论立体定向微创术能提高老年自发性丘脑出血患者血肿清除效果,减轻炎症反应,有助于患者早期神经功能恢复,降低患者意识障碍程度,缩短住院时间,增强日常活动能力,且能提高治疗安全性,改善患者预后。Objective To investigate the value of stereotactic minimally invasive surgery in the treatment of elderly patients with spontaneous thalamic hemorrhage.Methods Ninety-nine patients with spontaneous thalamic hemorrhage admitted to Ziyang Hospital of Traditional Chinese Medicine from April 2020 to May 2022 were selected and were randomly divided into two groups.The control group(n=49)received conservative drug therapy,and the study group(n=50)received stereotactic microtrauma therapy.Hematoma volume,fraction of anisotropy(FA)value,serum inflammatory factors(C-reactive protein(CRP),matrix metalloproteinase-9(MMP-9),tumor necrosis factorα(TNF-α))and prognostic factors(nuclear factor-κB p65(NF-κB p65),platelet-derived growth faction-D(PDGF-D),neurite outgrowth inhibitor A(Nogo-A))levels,neurological function(NIHSS score),degree of disturbance of consciousness(GCS score),ability of daily living(MBI score),complications,length of hospital stay were compared between the two groups before and after treatment.All the patients were followed up for 3 months after discharge.The prognosis of the two groups was statistically compared.Results One and two weeks after treatment,the control group,the volume of hematoma in the study group was lower than that in and the FA value was higher than that in the control group(P<0.05).The levels of CRP,MMP-9,TNF-α,NF-κB p65,PDGF-D and Nogo-A in the study group were lower than those in the control group 1 month and 3 months after treatment(P<0.05).One month and three months after treatment,the NIHSS score of the research group was lower than that of the control group,and the GCS and MBI scores were higher than those of the control group(P<0.05).The incidence of bleeding,pulmonary infection and lower limb venous thrombosis in the study group was lower than those in the control group,and the length of hospitalization was shorter than that in the control group(P<0.05).The good prognosis rate of the study group(76.00%)was higher than that of the control group(55.10%,P<0.05).Conclusion Ster

关 键 词：丘脑出血 立体定向 微创术 炎性因子 神经功能 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]