两种微创手术治疗基底节区高血压脑出血的疗效对比及与血清NSE相关性研究

发布时间：2018-06-19 00:44

  本文选题：脑出血 + 微创手术　； 参考：《福建中医药大学》2015年硕士论文

【摘要】：目的：探讨“锁孔”开颅血肿清除术和穿刺抽吸引流术两种手术方法在治疗基底节区高血压脑出血(hypertensive intracerebral hemorrhage, HICH)疗效的差别及与血清神经元特异性烯醇化酶(neuron-specific enolase, NSE)水平变化相关性。方法：设立“锁孔”开颅手术组,穿刺抽吸引流手术组和正常健康组。根据入组条件,选取基底节区HICH患者68例,根据手术方式分为“锁孔”开颅血肿清除术组(以下称锁孔组)及穿刺抽吸引流组(以下称穿刺组),随机抽取健康对照组20例测定血清NSE水平。比较两组患者手术时间、血肿清除率、手术并发症、术中出血量及病死率差异。动态测定并观察锁孔组和穿刺组患者术前、术后3d、7d、14d的血清NSE浓度变化,并相应地在各时间点采用美国国立卫生院卒中量表(NIH stroke scale, NIHSS)评定神经功能缺损情况,分析血清NSE水平与NIHSS评分之间的相关性,术后28d时采用Barthel指数评估日常生活能力(Activities of daily living, ADL)以对比两组间近期预后的差异。结果：1.两组患者在手术时间、血肿清除率、术中出血量以及拔管时间方面均有显著性差异(P0.05)。而在手术并发症及病死率方面相比无显著性差异(P0.05),但有锁孔组的手术并发症发生率低于穿刺组的趋势。术后28d随访,锁孔组ADL评分高于穿刺组,差异具有统计学意义(P0.05)。2.两组血清NSE水平及NIHSS评分在术后3d达到峰值,在术后7d及14天均呈逐渐下降趋势,但穿刺组下降幅度不如锁孔组明显,并且在术后7d及14d时显示出显著性差异(P0.05),重复测量方差分析得出两组整体间差异具有统计学意义(P0.05)。3.两组患者在术后3d、7d、14d NIHSS评分与NSE含量均呈现出明显的正相关性(0r1, P0.05),但两组术前NIHSS评分与NSE的水平无显著性相关(P0.05)。结论：1.对于基底节区HICH的患者,当术前血肿量在30-60ml、无脑疝发生、血肿未破入脑室时、格拉斯哥昏迷评分(Glasgow coma scale, GCS)≤12分时,两种微创手术治疗方式均有效,但是锁孔组患者血肿清除更彻底、术后恢复更快,整体优势优于穿刺组,可首先考虑“锁孔”开颅血肿清除术。2.两组患者血清NSE动态表达与神经功能缺损表现呈明显正相关,可作为评价两种微创手术的临床疗效和近期预后的参考指标。
[Abstract]:Objective: to investigate the effect of "keyhole" craniotomy and aspiration drainage in the treatment of hypertensive intracerebral hemorrhage (HICHs) in basal ganglia and its correlation with the level of neuron-specific enolase (NSE) in patients with hypertensive intracerebral hemorrhage (HICHs) in basal ganglia. Methods: the group of keyhole craniotomy, the group of aspiration and drainage and the group of normal health were established. According to the condition of entering the group, 68 patients with HICH in basal ganglia were selected. According to the operation mode, the patients were divided into "keyhole" craniotomy group (hereinafter referred to as keyhole group) and puncture aspiration and drainage group (hereinafter referred to as puncture group), and 20 cases of healthy control group were randomly selected to determine serum NSE level. The operative time, hematoma clearance rate, operative complications, intraoperative blood loss and mortality were compared between the two groups. The changes of serum NSE levels in the keyhole group and puncture group were measured dynamically before operation and at 3 days and 7 days after operation. The neurological impairment was assessed by the National Institutes of Health Stroke scale (NIHSS) at each time point. To analyze the correlation between serum NSE level and NIHSS score, the activities of daily living, ADL was evaluated by Barthel index 28 days after operation to compare the difference of short-term prognosis between the two groups. The result is 1: 1. There were significant differences in operation time, hematoma clearance rate, blood loss during operation and extubation time between the two groups (P 0.05). However, there was no significant difference in operative complications and mortality between the two groups, but the incidence of operative complications in the keyhole group was lower than that in the puncture group. After 28 days follow-up, ADL score in keyhole group was higher than that in puncture group, the difference was statistically significant. The serum NSE level and NIHSS score of the two groups reached the peak on the 3rd day after operation, and gradually decreased on the 7th and 14th days after operation, but the decline rate in the puncture group was not as obvious as that in the keyhole group. There was significant difference between the two groups on the 7th and 14th day after operation (P 0.05). The analysis of variance of repeated measurement showed that the difference between the two groups was statistically significant (P 0.05). There were significant positive correlations between NIHSS score and NSE content in both groups on the 3rd day, 7th day and 14th day after operation, but there was no significant correlation between NIHSS score and NSE level before operation in both groups (P 0.05). Conclusion 1. For patients with basal ganglia HICH, when the preoperative hematoma volume was 30-60 ml, no hernia occurred, and the hematoma did not break into the ventricle, Glasgow coma scale (GCSs) 鈮，

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