摘要
目的研究经额叶入路神经内镜治疗高血压脑出血(HICH)及对脑部血流动力学、神经损伤相关蛋白、微小RNA的影响。方法前瞻性选取2021年1月至2024年12月山西医科大学附属运城市中心医院收治的84例HICH患者作为研究对象,按照随机数字表法将其分为试验组(n=42)和对照组(n=42)。试验组行经额叶入路治疗,对照组行经颞叶入路治疗。观察两组术中出血量、手术时间、术后引流时间、术后脑水肿量、血肿清除率、住院时间等围手术期指标。比较术后7 d两组的脑部血流动力学指标[双侧大脑总动脉平均血流速度(V)、平均血流量(Q)及收缩期外周阻力(R)]、血清神经损伤相关蛋白[巨噬细胞炎症蛋白-1α(MIP-1α)、Ⅲ型纤维连接蛋白域蛋白5(FNDC5)、能量平衡相关蛋白Adropin]水平、血清miRNA(miRNA-132、miRNA-155)相对表达量以及术后并发症发生情况。结果试验组术后引流时间为(66.53±6.89)h,短于对照组[(71.75±7.36)h],试验组血肿清除率为92.86%,高于对照组(80.95%),差异均有统计学意义(P<0.05);两组术中出血量、手术时间、术后脑水肿量、住院时间比较,差异均无统计学意义(P>0.05)。试验组总有效率为97.62%,高于对照组(80.95%),差异有统计学意义(P<0.05)。术后7 d,试验组V、Q分别为(1131.38±124.06)mL/min、(18.32±2.12)cm/s,均高于对照组[(1089.27±114.94)mL/min、(17.25±1.93)cm/s],试验组R为(1.49±0.16)Pa·s/mL,低于对照组[(1.58±0.17)Pa·s/mL],差异均有统计学意义(P<0.05)。术后7 d,试验组MIP-1α水平为(144.72±16.58)ng/L,低于对照组[(152.67±17.49)ng/L],试验组FNDC5、Adropin水平分别为(0.57±0.07)ng/mL、(2.96±0.32)μg/mL,均高于对照组[(0.54±0.06)ng/mL、(2.79±0.29)μg/mL],差异均有统计学意义(P<0.05)。术后7 d,试验组miRNA-132、miRNA-155水平分别为1.46±0.16、1.42±0.15,均低于对照组(1.55±0.17、1.50±0.16),差异均有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论经额叶入路神经内镜治疗HICH可有效清除血肿,提高疗效,改善脑部血流动力学及血清神经损伤相关蛋白、微小RNA水平,且术后并发症发生率低。
Objective To investigate the effects of frontal approach neuroendoscopy on hypertensive intracerebral hemorrhage(HICH)and its effects on cerebral hemodynamics,nerve injury-related proteins and micrornas.Methods A total of 84 patients with HICH admitted to Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2021 to December 2024 were prospectively selected as the study subjects.According to the random number table method,they were divided into the experimental group(n=42)and the control group(n=42).The experimental group received transfrontal approach and the control group received transtemporal approach.The perioperative indexes such as intraoperative blood loss,operation time,postoperative drainage time,postoperative cerebral edema volume,hematoma clearance rate and hospitalization time were observed in the two groups.The cerebral hemodynamic indexes[mean blood flow velocity(V),mean blood flow(Q)and systolic peripheral resistance(R)of bilateral common cerebral arteries],serum nerve injury-related proteins[macrophage inflammatory protein-1α(MIP-1α),fibronectin typeⅢdomain-containing protein 5(FNDC5),energy balance-related protein Adropin],relative expression of serum miRNA(miRNA-132,miRNA-155)before and 7 days after operation and postoperative complications were compared between the two groups.Results The postoperative drainage time of the experimental group was(66.53±6.89)h,which was shorter than that of the control group[(71.75±7.36)h],and the hematoma clearance rate of the experimental group was 92.86%,which was higher than that of the control group(80.95%),the differences were statistically significant(P<0.05).There were no statistically significant differences in the amount of intraoperative blood loss,operation time,postoperative cerebral edema and length of hospital stay between the two groups(P>0.05).The total effective rate of the experimental group was 97.62%,which was higher than that of the control group(80.95%),and the difference was statistically significant(P<0.05).At 7 days after operation,V and Q in the experimental group were(1131.38±124.06)mL/min and(18.32±2.12)cm/s,respectively,which were higher than those in the control group[(1089.27±114.94)mL/min and(17.25±1.93)cm/s],and R in the experimental group was 1.49±0.16 Pa·s/mL,which was lower than that in the control group[(1.58±0.17)Pa·s/mL],the differences were statistically significant(P<0.05).At 7 days after operation,the level of MIP-1αin the experimental group was(144.72±16.58)ng/L,which was lower than that in the control group[(152.67±17.49)ng/L],the levels of FNDC5 and Adropin in the experimental group were(0.57±0.07)ng/mL and(2.96±0.32)μg/mL,respectively,which were higher than those in the control group[(0.54±0.06)ng/mL,(2.79±0.29)μg/mL],the differences were statistically significant(P<0.05).At 7 days after operation,the levels of miRNA-132 and miRNA-155 in the experimental group were 1.46±0.16 and 1.42±0.15,respectively,which were lower than those in the control group(1.55±0.17,1.50±0.16),the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The treatment of HICH by neuroendoscopy via frontal approach can effectively clear hematoma,improve therapeutic effect,improve brain hemodynamics and serum levels of nerve injury-related proteins and micrornas,and lower the incidence of postoperative complications.
作者
李璞
杨渊
王中
LI Pu;YANG Yuan;WANG Zhong(Department of Neurosurgery,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Yuncheng Shanxi 044000,China)
出处
《临床和实验医学杂志》
2025年第21期2254-2258,共5页
Journal of Clinical and Experimental Medicine
基金
2022年度山西省高等学校科技创新计划项目(编号:2022L516)。
关键词
经额叶入路
神经内镜
高血压脑出血
脑部血流动力学
神经损伤相关蛋白
微小RNA
Transfrontal approach
Neuroendoscopy
Hypertensive cerebral hemorrhage
Cerebral hemodynamics
Nerve damage associated protein
MicroRNA
