基于NIHSS评分探讨2种清除术治疗急性脑出血的临床效果  

Clinical Efficacy of Soft-channel Minimally Invasive Puncture and Drainage and Hematoma Removal by Craniotomy in Acute Cerebral Hemorrhage

作　　者：扶元森 FU Yuan-sen(Department of Neurosurgery,Guangshan County People’s Hospital,Xinyang 465450,China)

机构地区：[1]光山县人民医院神经外科,河南信阳465450

出　　处：《实用临床医学（江西）》2024年第4期53-57,共5页Practical Clinical Medicine

摘　　要：目的探讨软通道微创穿刺血肿清除术与开颅血肿清除术治疗急性脑出血的临床效果及对美国国立卫生研究院卒中量表(NIHSS)评分、术后并发症发生率的影响。方法回顾性分析75例急性脑出血患者的临床资料,按不同手术方式分为A组(行软通道微创穿刺血肿清除术,n=40)、B组(行开颅血肿清除术,n=35)。比较2组手术相关指标(住院时间、手术时间、出血量)、手术前后脑部血流动力学[动脉搏动指数(PI)、动脉平均流速(Vm)]、神经功能[中枢神经系统的特异性蛋白(S100β蛋白)、可溶性髓系细胞触发受体-1(sTREM-1)、神经特异性烯醇化酶(NSE)]、NIHSS和简易智能状态量表(MMSE)评分及术后并发症发生率。结果A组住院时间和手术时间短于B组,出血量少于B组(均P<0.001)。术后1、3个月,A组PI指数和NIHSS评分低于B组,Vm指标和MMSE评分高于B组(P<0.01或P<0.001)。术后1周,A组血清S100β蛋白、sTREM-1、NSE水平较B组低(P<0.05或P<0.001)。2组术后并发症发生率比较差异无统计学意义(2.50%比8.57%,P>0.05)。结论急性脑出血患者行软通道微创穿刺血肿清除术能加快脑部血流流速,改善认知能力,降低对神经功能损伤,缩短住院时间,促进患者早日康复。Objective To investigate clinical efficacy of soft-channel minimally invasive puncture and drainage and hematoma removal by craniotomy in the management of acute cerebral hemorrhage and to compare their effects on National Institutes of Health Stroke Scale(NIHSS)scores and postoperative complication rates.Methods A total of 75 patients with acute cerebral hemorrhage admitted to our hospital from May 2021 to May 2023 were selected and divided into Group A(n=40)and Group B(n=35)according to different surgical methods.Group A were treated with soft-channel minimally invasive puncture and drainage,while Group B underwent removal of hematoma by craniotomy.Both groups were compared in terms of surgery-related indexes(hospitalization time,operation time,and bleeding volume),preoperative and postoperative cerebral hemodynamic parameters[arterial pulsatility index(PI),mean arterial velocity(Vm)],neurological function[CNS-specific proteins(S100βprotein),soluble myeloid triggered receptor-1(sTREM-1),neural specific enolase(NSE)],the scores of NIHSS and the Brief Mental Status Scale(MMSE),as well as the incidence of postoperative complications.Results Group A had shorter hospitalization time,shorter operation time,and less bleeding than group B(both P<0.001).At 1 and 3 months postoperatively,the PI index and NIHSS score were lower in group A than those in group B,and the Vm index and MMSE score were higher than those in group B(P<0.01 or P<0.001).At 1 week postoperatively,serum S100βprotein,sTREM-1,and NSE levels were lower in group A than those in group B(P<0.05 or P<0.001).There was no statistically significant difference in the incidence of postoperative complications between the 2 groups(2.50%versus 8.57%,P>0.05).Conclusions Soft-channel minimally invasive puncture and drainage can accelerate cerebral blood flow,improve cognitive ability,reduce neurological function damage,shorten hospitalization time,and promote the early recovery in patients with acute cerebral hemorrhage.

关 键 词：急性脑出血 软通道微创穿刺血肿清除术 开颅血肿清除术 NIHSS量表 

分 类 号：R651.1[医药卫生—外科学] R743.34[医药卫生—临床医学]