术前DTI辅助神经内镜血肿清除术治疗老年脑出血患者的效果及预后观察  

Effect and Prognosis of Preoperative DTI-Assisted Neuroendoscopic Hematoma Evacuation in the Treatment of Elderly Patients with Intracerebral Hemorrhage

作　　者：熊俊彦 张化明 XIONG Junyan;ZHANG Huanming(China Resources Wisco General Hospital,Wuhan University of Science and Technology,Hubei Wuhan 430080,China)

机构地区：[1]武汉科技大学附属华润武钢总医院神经外科,湖北武汉430080 [2]武汉科技大学医学院,湖北武汉430070

出　　处：《河北医学》2025年第2期301-305,共5页Hebei Medicine

基　　金：湖北省卫生健康委员会科研项目,(编号:WJ2021M032)。

摘　　要：目的:观察术前弥散张量成像(DTI)辅助神经内镜血肿清除术治疗老年脑出血患者的效果及预后。方法:选取武汉科技大学医学院2021年5月至2023年5月收治的118例老年脑出血患者为研究对象,依照随机数表完全随机化分组法分为对照组(n=59)和DTI组(n=59)。对照组实施神经内镜血肿清除术治疗,DTI组实施术前DTI辅助神经内镜血肿清除术治疗。比较两组围术期基本情况,观察术前、术后1d两组脑组织损伤情况,对比术前、术后1d、3d、7d两组患者昏迷程度,统计两组术后并发症及术后再出血率发生率。结果:DTI组血肿清除时间、住院时间低于对照组(P<0.05),DTI组血肿清除率高于对照组(P<0.05)。术后1d,两组S100-β水平较术前均有升高(P<0.05),两组SOD水平较术前均有降低(P<0.05),且对照组变化幅度更显著(P<0.05)。两组GCS评分呈逐渐升高趋势(P<0.05),术后7d,DTI组GCS评分高于对照组(P<0.05)。DTI组术后并发症总发生率、再出血率均低于对照组(P<0.05)。结论:术前DTI辅助神经内镜血肿清除术治疗老年脑出血患者效果显著,可避免脑组织损伤,且术后并发症较少,预后情况较好。Objective:To observe the effect and prognosis of preoperative Diffusion Tensor Imaging(DTI)-assisted neuroendoscopic hematoma evacuation in elderly patients with intracerebral hemorrhage.Methods:A total of 118 elderly patients with intracerebral hemorrhage who were treated at Huazhong University of Science and Technology from May 2021 to May 2023 were enrolled in this study.The patients were randomly divided into two groups using a random number table method:the control group(n=59)and the DTI group(n=59).The control group received neuroendoscopic hematoma evacuation,while the DTI group received preoperative DTI-assisted neuroendoscopic hematoma evacuation.The perioperative basic conditions of the two groups were compared,and brain tissue damage was observed preoperatively and 1 day postoperatively.The Glasgow Coma Scale(GCS)scores were compared at preoperative,postoperative 1 day,3 days,and 7 days,and the postoperative complication rate and rebleeding rate were recorded.Results:The hematoma evacuation time and hospital stay in the DTI group were shorter than those in the control group(P<0.05).The hematoma clearance rate in the DTI group was higher than that in the control group(P<0.05).One day postoperatively,the S100-β levels in both groups increased compared to preoperative levels(P<0.05),and the SOD levels decreased(P<0.05),with a more significant change in the control group(P<0.05).The GCS scores of both groups showed a gradually increasing trend(P<0.05),and the GCS score of the DTI group was higher than that of the control group on postoperative day 7(P<0.05).The total incidence of postoperative complications and rebleeding rate were lower in the DTI group than in the control group(P<0.05).Conclusion:Preoperative DTI-assisted neuroendoscopic hematoma evacuation significantly improves the outcome in elderly patients with intracerebral hemorrhage,avoids brain tissue damage,and results in fewer postoperative complications and a better prognosis.

关 键 词：弥散张量成像 神经内镜血肿清除术 老年患者 脑出血 预后 

分 类 号：R651.12[医药卫生—外科学]