摘要
目的 探讨神经内镜下不同入路血肿清除术治疗高血压脑出血(HICH)患者的效果。方法 回顾性分析2020年6月至2022年10月行血肿清除术的80例HICH患者病例资料,根据手术入路将患者分为经颞部入路组(38例)和经额部入路组(42例),比较两组患者围手术期指标;采用美国国立卫生研究院卒中量表(NIHSS)比较术前和术后7、14 d的神经功能缺损程度;术前、术后比较生化指标[肿瘤坏死因子-ɑ(TNF-ɑ)、C反应蛋白(CRP)、神经元特异性烯醇化酶(NSE)]、脑部血流动力学指标[平均血流量(Q)、平均血流速度(V)、双侧大脑总动脉收缩期的外周阻力(R)];术后1个月,比较两组患者格拉斯哥预后量表(GOS)评分及术后并发症。结果 术后,两组手术时间、术中出血量差异无统计学意义(P>0.05),且经额部入路组术后血肿清除率高于经颞部入路组(P<0.05),引流拔管时间短于经颞部入路组(P<0.05)。两组NIHSS评分组间、时间点及交互作用有统计学意义(P<0.05),观察组术后7、14 dNIHSS评分均低于对照组(P<0.05)。术后,经额部入路组TNF-ɑ、CRP、NSE水平低于经颞部入路组(P<0.05)。经额部入路组R低于经颞部入路组(P<0.05),且Q、V高于经颞部入路组(P<0.05)。经额部入路组GOS评分优于经颞部入路组(P<0.05)。两组并发症总发生率差异无统计学意义(P>0.05)。结论 经额部入路相比经颞部入路治疗HICH患者更能提高血肿清除率,缩短拔管时间,改善患者脑部血流动力,降低炎症反应,减少脑神经损伤,提高预后情况,且具有一定安全性。
Objective To explore the curative effect of neuroendoscopic evacuation of hematoma through different approaches on patients with hypertensive intracerebral hemorrhage(HICH).Methods A retrospective analysis was performed on the clinical data of 80 patients with HICH undergoing evacuation of hematoma from June 2020 to October 2022.According to surgical approaches,they were divided into transtemporal approach group(38 cases)and transfrontal approach group(42 cases).The perioperative indexes in the two groups were compared.The severity of neurological impairment was compared by National Institutes of Health stroke scale(NIHSS)before surgery,at 7 and 14 days after surgery.The biochemical indexes[tumor necrosis factorɑ(TNF-ɑ),C-reactive protein(CRP),neuron-specific enolase(NSE)]and cerebral hemodynamics indexes[mean blood flow(Q),mean velocity(V),systole peripheral resistance of bilateral common cerebral artery(R)]before and after surgery,scores of Glasgow outcome scale(GOS)at 1 month after surgery and postoperative complications in the two groups were compared.Results After surgery,there were no differences in operation time and intraoperative blood loss between the two groups(P>0.05).The hematoma clearance rate in transfrontal approach group was higher than that in transtemporal approach group(P<0.05),and removal time of drainage tube was shorter than that in transtemporal approach group(P<0.05).The groups,time points and interaction of NIHSS scores between the two groups were significant(P<0.05),and the NIHSS scores at 7 days and 14 days after the observation group were lower than that of the control group(P<0.05).After surgery,levels of TNF-ɑ,CRP and NSE in transfrontal approach group were lower than those in transtemporal approach group(P<0.05).R in transfrontal approach group was lower than that in transtemporal approach group(P<0.05),while Q and V were higher than those in transtemporal approach group(P<0.05).The GOS scores in transfrontal approach group was better than that in transtemporal approach group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Compared with transtemporal approach,transfrontal approach can better improve hematoma clearance rate,shorten extubation time,improve cerebral hemodynamics,reduce inflammatory response and cerebral nerve injury,and improve prognosis in HICH patients,with certain safety.
作者
张宾
马许辉
郑朋飞
ZHANG Bin;MA Xuhui;ZHENG Pengfei(Neurosurgery,Zhengzhou Yangcheng Hospital,Zhengzhou 452470,China)
出处
《河南医学研究》
2025年第3期424-428,共5页
Henan Medical Research
关键词
高血压脑出血
神经内镜
不同入路
血肿清除术
hypertensive intracerebral hemorrhage
neuroendoscope
different approach
evacuation of hematoma
