颅内血肿清除术联合颅内压监测治疗重症高血压脑出血的疗效及安全性研究  

Efficacy and safety of intracranial hematoma evacuation combined with intracranial pressure monitoring in the treatment of severe hypertensive intracerebral hemorrhage

作　　者：王俊善 常书锋 黄晓峰 杨万敬 WANG Jun-shan;CHANG Shu-feng;HUANG Xiao-feng;YANG Wan-jing(Department of Neurosurgery,Luoyang Third People's Hospital(the First Affiliated Hospital of Luoyang Vocational and Technical College),Luoyang 471000,Henan,CHINA)

机构地区：[1]洛阳市第三人民医院(洛阳职业技术学院第一附属医院)神经外科,河南洛阳471000

出　　处：《海南医学》2025年第7期958-962,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHG20210832)。

摘　　要：目的探究颅内血肿清除术联合颅内压监测对重症高血压脑出血患者临床疗效的影响。方法选取2020年1月至2023年1月洛阳市第三人民医院收治的79例重症高血压脑出血患者作为研究对象,按信封抽签法随机分为单一组(n=39)和联合组(n=40)。单一组患者给予颅内血肿清除术治疗,联合组患者给予颅内血肿清除术联合颅内压监测。比较两组患者治疗期间手术指标和治疗前后的血清指标、日常生活能力[日常生活活动能力量表(ADL)评分、Brathel指数量表]、神经功能[神经功能缺损程度评分(CSS)、美国国立卫生院卒中量表(NIHSS)评分]及治疗后的格拉斯哥预后分级(GOS)和不良事件发生情况。结果联合组患者的手术时间为(196.74±38.12)min,明显长于单一组的(148.67±24.71)min,血肿排空时间、住院时间分别为(7.50±0.73)d、(11.30±1.27)d,明显短于单一组的(10.90±1.05)d、(15.82±1.45)d,差异均有统计学意义(P<0.05);治疗后,联合组患者的内皮素-1(ET-1)、基质金属蛋白酶-9(MMP-9)、晚期氧化蛋白产物(AOPP)、皮质醇(Cor)、去甲肾上腺素(NE)水平分别为(49.38±3.71)pg/mL、(113.35±10.21)μg/L、(39.44±3.82)μmol/L、(18.55±1.39)pg/mL、(82.34±8.58)mg/mL,明显低于单一组的(62.85±5.18)pg/mL、(144.82±13.03)μg/L、(58.03±5.71)μmol/L、(23.19±2.46)pg/mL、(93.31±10.23)mg/mL,差异均有统计学意义(P<0.05);治疗后,联合组患者的ADL评分、Brathel指数分别为(77.11±6.42)分、(85.65±7.85)分,明显高于单一组的(53.09±5.66)分、(69.37±6.97)分,差异均有统计学意义(P<0.05);治疗后,联合组患者的CSS、NIHSS评分分别为(16.72±1.68)分、(18.38±1.37)分,明显低于单一组的(23.88±2.37)分、(26.55±2.72)分,差异均有统计学意义(P<0.05);治疗后联合组患者的恢复良好率为62.5%,明显高于单一组的20.5%,差异有统计学意义(P<0.05);联合组患者的术后并发症发生率为5.0%,明显低于单一组的20.5%,差异有统�Objective To investigate the clinical efficacy of intracranial hematoma evacuation combined with intracranial pressure(ICP)monitoring in patients with severe hypertensive intracerebral hemorrhage(HICH).Methods A total of 79 patients with severe HICH admitted to Luoyang Third People's Hospital from January 2020 to January 2023 were selected as the study subjects.They were randomly divided into a single-treatment group(n=39)and a combined-treatment group(n=40)using the envelope drawing method.The single-treatment group underwent intracranial hematoma evacuation alone,while the combined-treatment group received intracranial hematoma evacuation combined with ICP monitoring.Surgical indicators,serum markers,daily living ability(Activities of Daily Living[ADL]scale,Barthel Index),neurological function(Canadian Stroke Scale[CSS],National Institutes of Health Stroke Scale[NIHSS]),Glasgow Outcome Scale(GOS)scores,and adverse events were compared between the two groups before and after treatment.Results The operation time in the combined-treatment group was(196.74±38.12)minutes,significantly longer than(148.67±24.71)minutes in the single-treatment group.The hematoma evacuation time and hospital stay in the combined-treatment group were(7.50±0.73)days and(11.30±1.27)days,respectively,significantly shorter than(10.90±1.05)days and(15.82±1.45)days in the single-treatment group(P<0.05).After treatment,the levels of endothelin-1(ET-1),matrix metalloproteinase-9(MMP-9),advanced oxidation protein products(AOPP),cortisol(Cor),and norepinephrine(NE)in the combined-treatment group were(49.38±3.71)pg/mL,(113.35±10.21)μg/L,(39.44±3.82)μmol/L,(18.55±1.39)pg/mL,and(82.34±8.58)mg/mL,respectively,significantly lower than(62.85±5.18)pg/mL,(144.82±13.03)μg/L,(58.03±5.71)μmol/L,(23.19±2.46)pg/mL,and(93.31±10.23)mg/mL in the single-treatment group(P<0.05).After treatment,the ADL score and Barthel Index in the combined-treatment group were(77.11±6.42)points and(85.65±7.85)points,respectively,significantly higher than(53.0

关 键 词：重症高血压脑出血 颅内血肿清除术 颅内压监测 临床疗效 安全性 

分 类 号：R743.34[医药卫生—神经病学与精神病学]