内镜下血肿清除联合置管引流术对脑出血破入脑室患者血肿清除率及血清NSE、COR水平的影响  

Impact of endoscopic hematoma evacuation combined with catheter drainage on hematoma clearance rate and serum NSE and COR levels in patients with intracerebral hemorrhage into the ventricular system

作　　者：凌成明[1] 于泽奇 阮涛 文志鹏 郭浩 王宇 曾思玉 Ling Chengming;Yu Zeqi;Ruan Tao;Wen Zhipeng;Guo Hao;Wang Yu;Zeng Siyu(Department of Neurosurgery,Armed Police Forces Hospital of Sichuan,Leshan Sichuan 614000,China;Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu 610044,China)

机构地区：[1]武警四川总队医院神经外科,四川乐山614000 [2]四川大学华西医院神经外科,成都610044

出　　处：《保健医学研究与实践》2024年第7期63-68,78,共7页Health Medicine Research and Practice

基　　金：四川省科技计划项目(2023YFS0282)。

摘　　要：目的探讨内镜下血肿清除与置管引流术联合对脑出血破入脑室患者血肿清除率及血清神经元特异性烯醇化酶(NSE)、皮质醇(COR)水平的影响,以期为脑出血破入脑室患者的临床治疗提供参考。方法回顾性分析2020年1月—2022年9月于武警四川总队医院就诊的脑出血破入脑室患者的临床资料,将接受内镜下血肿清除联合置管引流术治疗的55例患者纳入观察组,将接受单纯置管引流术治疗的55例患者纳入对照组。比较2组患者手术后的血肿清除情况、引流管留置时间和术后并发症发生情况,2组患者术前和术后7 d的血清生化指标、脑循环动力学指标[平均血流速度(V_(mean))、平均血流量(Q_(mean))、外周阻力(R)、临界压力(CP)]和昏迷情况[格拉斯哥昏迷评分(GCS)],同时比较2组患者术后3个月的预后情况[格拉斯哥预后评分(GOS)]和日常生活能力[日常生活活动量表(ADL)评分]。结果观察组患者的血肿清除率高于对照组,引流管留置时间短于对照组,差异均有统计学意义(P<0.05)。2组患者术后并发症发生率比较,差异无统计学意义(χ^(2)=0.812,P=0.368)。术前,2组患者血清NSE和COR水平比较,差异均无统计学意义(P>0.05);术后7 d时,2组患者血清NSE和COR水平均低于术前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,2组患者V_(mean)、Q_(mean)、R及CP水平比较,差异均无统计学意义(P>0.05);术后7 d时,2组患者V_(mean)和Q_(mean)水平均高于术前且观察组均高于对照组,R和CP水平均低于术前且观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,2组患者GCS量表的睁眼反应、语言反应、肢体运动3个维度评分比较,差异均无统计学意义(P>0.05);术后7 d时,2组患者GCS量表的3个维度评分均高于术前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。术后3个月时,观察组患者GOS和ADL评分均高于对照组,差异均有统�Objective To investigate the impact of endoscopic hematoma evacuation combined with catheter drainage on the hematoma clearance rate and serum levels of neuron-specific enolase(NSE)and cortisol(COR)in patients with intracerebral hemorrhage(ICH)into the ventricular system,aiming to provide a reference for the clinical treatment of such patients.Methods A retrospective analysis was conducted on the clinical data of patients with ICH into the ventricular system who were treated at the Armed Police Forces Hospital of Sichuan from January 2020 to September 2022.A total of 55 patients who underwent endoscopic hematoma evacuation combined with catheter drainage were included in the observation group,and 55 patients who underwent simple catheter drainage were included in the control group.The hematoma clearance,duration of catheter placement,and occurrence of postoperative complications were compared between the two groups.Additionally,serum biochemical indicators,cerebral hemodynamic parameters[mean blood flow velocity(V_(mean)),mean blood flow(Q_(mean)),peripheral resistance(R),and critical pressure(CP)],and coma status[Glasgow Coma Scale(GCS)]were compared before and 7 days after surgery.The prognosis[Glasgow Outcome Scale(GOS)]and daily living abilities[Activities of Daily Living(ADL)score]at 3 months postoperatively were also compared.Results The hematoma clearance rate in the observation group was higher than that in the control group,and the duration of catheter placement was shorter than that in the control group,with both differences being statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(χ^(2)=0.812,P=0.368).No statistically significant differences were found preoperatively in serum NSE and COR levels between the two groups(P>0.05).At 7 days postoperatively,the serum levels of NSE and COR in both groups were lower than preoperatively,and the observation group had lower levels than the control group,with sta

关 键 词：血肿清除 置管引流术 脑出血破入脑室 术后康复 日常生活活动能力 脑循环 

分 类 号：R651.1[医药卫生—外科学]