CT定位辅助神经内镜手术与微创钻孔引流术治疗高血压脑出血临床疗效及安全性观察

Clinical efficacy and safety of CT positioning-assisted neuroendoscopic surgery and minimally invasive drilling drainage in the treatment of hypertensive intracerebral hemorrhage

目的探讨X线计算机断层摄影(CT)定位辅助神经内镜手术与微创钻孔引流术治疗高血压脑出血(HICH)临床疗效及安全性。方法回顾性分析2017年1月~2019年1月间收治的114例HICH患者临床资料,根据手术方法分为观察组(n=54)与对照组(n=60)。对照组应用微创钻孔引流术,观察组应用CT定位辅助神经内镜手术。比较两组血肿清除率及围术期状况(手术时间、术中出血量、住院时间)、术后并发症发生率,术前、术后7d,评估两组神经损伤相关指标[神经元特异性烯醇化酶(NSE)、神经营养因子(NTF-α)、胶质纤维酸性蛋白(GFAP)],术前、术后3个月,评估两组神经恢复情况[美国国立卫生研究院卒中量表(NIHSS)],比较两组术后6个月预后[Rankin修订量表评分(mRS)]。结果①观察组血肿清除率、手术时间和术中出血量高于对照组(P<0.05),两组住院时间、术后并发症、死亡率及预后良好率对比差异无统计学意义(P>0.05);②术后7d,两组NSE均低于术前(P<0.05),观察组降幅大于对照组(P<0.05),两组NTF-α、GFAP均高于术前(P<0.05),观察组增幅小于对照组(P<0.05);③术后3个月,两组NIHSS得分均低于术前(P<0.05),观察组降幅大于对照组(P<0.05)。结论CT定位辅助神经内镜手术与微创钻孔引流术治疗HICH均安全有效,前者在血肿清除、促进近期神经功能恢复方面更有优势。

Objective To investigate the clinical efficacy and safety of X-ray computed tomography(CT)positioning-assisted neuroendoscopic surgery and minimally invasive drilling drainage in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 114HICH patients admitted between January 2017and January 2019were retrospectively analyzed,and the patients were divided into observation group(n=54)and control group(n=60)according to the surgical methods.Control group was treated with minimally invasive drilling drainage while observation group was treated with CT positioning-assisted neuroendoscopic surgery.Hematoma clearance rate and perioperative status(surgical time,intraoperative blood loss,hospital stay)and incidence rate of postoperative complications were compared between the two groups,and the related indexes of nerve injury[neuron-specific enolase(NSE),neurotrophic factor(NTF-α),glial fibrillary acidic protein(GFAP)]were evaluated in the two groups before surgery and at 3months after surgery,and the neurological recovery[National Institutes of Health Stroke Scale(NIHSS)]before surgery and at 3months after surgery was assessed in the two groups,and the prognosis[Rankin Modified Scale Score(mRS)]at 6months after surgery was compared between the two groups.Results The hematoma clearance rate,surgical time and intraoperative blood loss in observation group were higher than those in control group(P<0.05),and there were no significant differences in the hospital stay,postoperative complications,mortality rate and good prognosis rate between the two groups(P>0.05).At 7d after surgery,the NSE in the two groups was lower than that before surgery(P<0.05),and the decrease in observation group was greater than that in control group(P<0.05),and the NTF-αand GFAP in the two groups were higher than those before surgery(P<0.05),and the increases in observation group were smaller than those in control group(P<0.05).At 3months after surgery,the NIHSS score in the two groups was lower than that before surgery(P<0.05),and the decrease in observation group was greater than that in control group(P<0.05).Conclusion CT positioning-assisted neuroendoscopic surgery and minimally invasive drilling drainage both are safe and effective in the treatment of HICH.The former one has advantages in removing hematoma and promoting recent neurological recovery.