传统骨瓣开颅和微骨窗入路对高血压脑出血患者预后和细胞免疫的影响

Effects of conventional open craniotomy and key-hole approach on neurosurgical management of hypertensive intracerebral hemorrhage and on cellular immunal function of these patients

目的 观察传统骨瓣开颅和微骨窗入路血肿清除术治疗高血压脑出血（HICH）的预后及其对细胞免疫的影响. 方法 选择肇庆市第一人民医院神经外科自2008年9月至2012年5月手术治疗的HICH患者83例,其中采用传统骨瓣开颅血肿清除术53例（传统骨瓣开颅组）,采用微骨窗入路血肿清除术30例（微骨窗入路组）.分别于术前、术后1d、7d3个时间点检测患者血清CD3、CD4和CD8阳性细胞百分率和CD4/CD8,观察术后患者感染性并发症的发生并采用日常生活能力（ADL）分级评定患者预后. 结果 与术前比较,2组患者术后1、7d血液CD3、CD4阳性细胞率和CD4/CD8比值降低,与术后1d比较,术后7dCD3、CD4阳性细胞率和CD4/CD8比值高,差异均有统计学意义（P＜0.05）；与传统骨瓣开颅组比较,微骨窗入路组患者术后1d、7 dCD3、CD4阳性细胞率和CD4/CD8比值较高,差异有统计学意义（P＜0.05）；传统骨瓣开颅组术后发生肺部感染率高于微骨窗入路组,差异有统计学意义（P＜0.05）. 结论 对于尚未发生脑疝的HICH,传统骨瓣开颅和微骨窗入路血肿清除术治疗预后相同,但微骨窗入路对患者细胞免疫的影响较小,可相对降低肺部感染的发生.

Objective To investigate the Effects of conventional open craniotomy and key-hole approach on neurosurgical management of hypertensive intracerebral hemorrhage （HICH） and on cellular immunal function of these patients.Methods Eighty-three patients with HICH,admitted to and performed operation in our hospital from September 2008 to May 2011 （53 underwent conventional open craniotomy and 30 underwent surgery via key hole approach） were chosen in our study.Their CD3,CD4 and CD8 positive cell percentage and ratio of CD4/CD8 in serum before operation and 1 and 7 d after operation were detected.The infectious complications were analyzed and prognoses were evaluated by activities of daily living （ADL） grading.Results The CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in serum 1 and 7 d after the operation were significantly decreased as compared with those before operation （P〈0.05）,and those 7 d after operation were significantly increased as compared with those 1 d after operation （P〈0.05）.One and 7 d after operation,the CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in the key hole approach group were significantly higher than those in the conventional open craniotomy group （P〈0.05）.The postoperative pulmonary infection rate in the conventional open craniotomy group was significantly higher than that in the key hole approach group （P〈0.05）.Conclusion As compared with conventional open craniotomy,surgery via key-hole approach has the same prognosis in treatment of HICH which has not yet occurred herniation,while the influence of cellular immunal function and the incidence of lung infection is relatively lower.