神经内镜与硬通道血肿穿刺治疗丘脑出血的对比研究

发布时间：2018-02-27 16:51

本文关键词： 丘脑出血神经内镜白细胞介素6 补体C3 补体C4　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨神经内镜与硬通道血肿穿刺治疗丘脑出血的有效性。方法:分析40例丘脑出血患者神经内镜与硬通道血肿穿刺手术的治疗对比。术后通过血肿测量软件计算血肿清除率;比较术前、术后1、2、3、7、14日血清中白细胞介素-6、补体C3、C4浓度,分析炎性因子浓度的统计学差异;通过计算CT显示脑水肿最大层面面积,进行术后脑水肿情况的对比;术后并发症发生率;分析格拉斯哥预后评分:5分-基本恢复正常生活,4分-轻度残疾但可独立生活,3分-重度残疾、清醒,2分-植物生存,1分-死亡。结果:神经内镜组(观察组)患者预后良好11例,重残8例,死亡2例;硬通道血肿穿刺组(对照组)预后良好8例,重残7例,死亡4例,观察组死亡率和术后再出血率明显低于对照组。术后24小时血肿清除率,内镜组为82%,穿刺组为58%,两组数据差异具有统计学意义;炎性因子补体C3、补体C4、白细胞介素-6(IL-6)数据比较有显著性差异;观察组患者的血肿清除率、炎性因子指标、脑水肿等数据,均优于对照组,差异比较均有显著性差异(P0.05)。结论:神经内镜组可以在短时间内达到减压效果,提高血肿清除率、降低再出血风险,从而减轻炎性反应、避免对周围脑组织的继发性损伤。对于出血量较大的丘脑出血患者,神经内镜手术可以明显降低死亡率,改善患者预后。
[Abstract]:Objective: to investigate the effectiveness of endoscopic and hard channel hematoma puncture in the treatment of thalamic hemorrhage. Methods: 40 patients with thalamic hemorrhage were treated by endoscopy and hard channel hematoma puncture. Soft hematoma was measured after operation. The hematoma clearance rate was calculated. In 14th, the concentration of interleukin-6 and complement C _ 3 C _ 4 in serum were compared to analyze the statistical difference of inflammatory factor concentration, the maximum area of cerebral edema was shown by computed tomography (CT), and the postoperative cerebral edema was compared. The incidence of postoperative complications, Glasgow prognostic score: 5 points-basic return to normal life, 4 points-mild disability but can live independently, 3 points-severe disability, Results: there were 11 patients with good prognosis, 8 patients with severe disability and 2 patients with death in the neuroendoscopy group (observation group), 8 patients in the hard passage hematoma puncture group (control group) had a good prognosis, 7 patients with severe disability and 4 patients died. The mortality and rebleeding rate in the observation group were significantly lower than those in the control group. The hematoma clearance rate was 82 in the endoscopic group and 58 in the puncture group at 24 hours postoperatively. The difference between the two groups was statistically significant. The data of inflammatory factor C3, complement C4, interleukin-6 (IL-6) were significantly different, the hematoma clearance rate, inflammatory factor index, cerebral edema and other data in the observation group were better than those in the control group. Conclusion: the neuroendoscopy group can achieve decompression effect in a short time, increase hematoma clearance rate, reduce the risk of rebleeding, and reduce inflammatory reaction. To avoid secondary injury to peripheral brain tissue, neuroendoscopy can significantly reduce mortality and improve prognosis in patients with large amount of hemorrhage of thalamus.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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