改良颅内血肿微创清除术对脑出血患者血脑屏障功能的影响

Effects of improved-microinvasive hematoma evacuation on blood-brain barrier in patients with cerebral hemorrhage

目的探讨改良颅内血肿微创清除术对脑出血患者血脑屏障功能的影响。方法选取我院脑出血患者82例，根据病情及家属治疗意愿分为微创治疗组（31例）、小骨窗治疗组（30例）和保守治疗组（21例）。保守治疗组给常规治疗，小骨窗治疗组在常规治疗基础上行小骨窗开颅术，微创治疗组在常规治疗基础上行改良颅内血肿微创清除术。检测治疗前后血脑屏障指数和血清髓鞘碱性蛋白的变化。随机抽取10例腹外疝患者蛛网膜下腔阻滞麻醉时留取脑脊液并抽静脉血，作为正常对照。结果治疗前，3组患者血脑屏障指数和血清髓鞘碱性蛋白浓度无明显差别，而治疗后3、7d，微创治疗组血脑屏障指数及血清髓鞘碱性蛋白浓度明显低于小骨窗治疗组和保守治疗组，差异有统计学意义[治疗后3d微创治疗组、小骨窗治疗组和保守治疗组血脑屏障指数分别为（0．0095±0．0008）、（0．0125±0．0011）、（0．0129±0．0009），髓鞘碱性蛋白浓度分别为（8．3±1．3）、（11．3±1．4）、（12．0±1．6）μg／L；治疗后7d微创治疗组、小骨窗治疗组和保守治疗组血脑屏障指数分别为（0．0066±0．0008）、（0．0098±0．0007）、（0．0103±0．0011），髓鞘碱性蛋白浓度分别为（2．2±0．7）、（5．2±0．7）、（5．4±0．6）μg／L，P〈0．05]。结论改良颅内血肿微创清除术可以减轻脑出血后细胞毒性对血脑屏障的损伤，从而减轻继发性脑损害。

[ Abstract] Objective To explore the effects of improved-mieroinvasive hematoma evacuation on blood- brain barrier （BBB） in patients with cerebral hemorrhage. Methods Valid patients with cerebral hemorrhage were divided into microinvasive hematoma evacuation group, small bone flap craniotomy group and conventional group. The patients in conventional group received the routine treatment, while small bone flap craniotomy group received the same treatment together with small bone flap craniotomy and mieroinvasive hematoma evacuation group also re- ceived the same treatment together with improved-microinvasive hematoma evacuation. The BBB index and myelin basic protein （MBP） were measured and analyzed before and after treatment respectively. Results There were no significant differences in BBB index and MBP among three groups before treatment. However, the BBB index and MBP in microinvasive hematoma evacuation group were signifieandy lower than those in small bone flap craniotomy group and conventional group after 3 days and 7 days treatmentl after 3 days treatment, BBB index of microinvasive hematoma evacuation group, small bone flap eraniotomy group and conventional group were 0. 0095 ± 0. 0008, 0.0125±0.0011,0.0129±0.0009, MBPwere（8.3 ±1.3）, （11.3±1.4）, （12.0±1.6）μg/L;after7 days treatment, BBB index of microinvasive hematoma evacuation group, small bone flap craniotomy group and conven- tional group were 0.0066 ±0.0008, 0.0098 ± 0.0007, 0.0103 ± 0. 0011, MBP were （ 2.2 ± 0.7 ）, （ 5.2 ± 0.7 ）, （ 5.4 ± 0.6） μg/L, P 〈 0.05 ]. Conclusion Improved-Microinvasive hematoma evacuation can reduce the lesion of cytotoxicity to BBB after cerebral hemorrhage.