传统开颅血肿清除术和神经内镜血肿清除术对高血压性基底节脑出血的术后炎症、神经功能以及治疗效果影响  

Effect of different surgical procedures on hypertensive intracerebral hemorrhage in the basal ganglion and their effect on inflammation and neurological function

作　　者：孙向 刘永生[1] 郭士琨[1] 苗鹏飞[1] Sun Xiang;Liu Yongsheng;Guo Shikun;Miao Pengfei(Department of Neurosurgery,the First People’s Hospital of Shangqiu City,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院神经外科,商丘476000

出　　处：《中华实验外科杂志》2024年第8期1844-1847,共4页Chinese Journal of Experimental Surgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210989)。

摘　　要：目的探讨传统开颅血肿清除术和神经内镜血肿清除术对高血压性基底节区脑出血的治疗效果及其对患者炎症水平和神经功能的影响。方法选取2021年10月至2023年5月在商丘市第一人民医院接受诊断治疗的首次高血压性基底节区脑出血患者82例,采用抽签法将所有患者分为对照组(41例)和观察组(41例)。对照组给予传统开颅血肿清除术,观察组给予神经内镜血肿清除术。比较两组患者的术中出血量、血肿清除率、术后并发症发生率;患者术后外周血白细胞介素(IL)-1β、IL-6和肿瘤坏死因子-α(TNF-α)水平采用酶联免疫吸附法检测;采用中枢神经特异性蛋白(S100)和神经元特异性烯醇化酶(NSE)电化学发光试剂盒检测患者术后S100、NSE血清水平;采用美国国立卫生院卒中量表(NIHSS)评价脑出血患者治疗前后神经功能障碍;采用格拉斯哥昏迷量表(GCS)评价脑出血患者治疗前后意识水平。组间计量数据比较采用独立样本t检验。结果观察组患者的血肿清除率[(90.02±3.95)%]明显高于对照组[(82.07±5.16)%],术中出血量[(33.70±4.16)ml]和术后并发生发生率[4.88%(2/41)]明显低于对照组[(49.67±5.70)ml、21.95%(9/41)],差异有统计学意义(t=7.83、14.49、5.15,P<0.05)。术后3 d,观察组患者的血清TNF-α[(249.41±20.38)pg/ml]、IL-6[(65.56±6.35)pg/ml]、IL-1β[(201.77±19.84)pg/ml]水平均明显低于对照组患者[(312.77±24.20)、(88.40±7.37)、(284.31±19.27)pg/ml],差异有统计学意义(t=12.82、15.03、19.11,P<0.05)。术后3 d,观察组患者的血清S100[(0.29±0.03)μg/L]、NSE[(26.31±3.70)ng/ml]水平均明显低于对照组患者[(0.35±0.04)μg/L、(32.97±4.57)ng/ml],差异有统计学意义(t=8.83、7.25,P<0.05)。治疗前观察组和对照组的NIHSS评分[(28.27±2.39)、(28.78±2.07)分]和GCS评分[(7.80±1.75)、(8.05±1.61)分]比较,差异无统计学意义(t=1.04、0.66,P>0.05)。治疗后观察组患者的NIHSS评分[(15.15±1.13)分]�ObjectiveTo investigate the effect of neuroendoscopy and traditional craniotomy on hypertensive intracerebral hemorrhage in the basal ganglion and their effect on inflammation and neurological function.MethodsA total of 82 patients with initial hypertensive intracerebral hemorrhage in the basal ganglion and treated in the First People’s Hospital of Shangqiu City from October 2021 to May 2023 were selected,and all patients were divided into control group(41 cases)and observation group(41 cases)using the random number table method.The control group was given traditional craniotomy haematoma removal and the observation group was given neuroendoscopy.Intraoperative haemorrhage,haematoma clearance,and postoperative complication rates were compared between the two groups.Tumor necrosis factor-α(TNF-α),interleukin(IL)-6,and IL-1βenzyme linked immunosorbent assay(ELISA)kits were used to detect postoperative TNF-α,IL-6,and IL-1βserum levels.Postoperative serum levels of S100 and neuron specific enolase(NSE)were measured using electrochemiluminescence kits.The NIHSS scores were used to evaluate the neurological dysfunction of cerebral hemorrhage patients,and GCS was used to evaluate the consciousness level of patients with cerebral hemorrhage.Independent sample t test was used to compare the measurement data between groups.ResultsThe haematoma clearance rate[(90.02±3.95)%]of patients in the observation group was significantly higher than that in the control group[(82.07±5.16)%],and the intraoperative bleeding volume[(33.70±4.16)ml]and postoperative concurrent incidence rate[4.88%(2/41)]were significantly lower in the observation group than in the control group[(49.67±5.70)ml,21.95%(9/41),t=7.83,14.49,5.15,P<0.05].At 3rd day after surgery,the serum TNF-α[(249.41±20.38)pg/ml],IL-6[(65.56±6.35)pg/ml],and IL-1β[(201.77±19.84)pg/ml]levels in the observation group were significantly lower than those in the control group[(312.77±24.20),(88.40±7.37),(284.31±19.27)pg/ml,t=12.82,15.03,19.11,P<0.05].At 3rd day afte

关 键 词：神经内镜血肿清除术 高血压性脑出血 炎性因子 神经功能 

分 类 号：R651.12[医药卫生—外科学]