高血压基底节区脑出血患者微创术后应用神经生长因子的效果观察

The Effect of NGF on the Patients with Hypertensive Basal Ganglia Hemorrhage after Minimally Invasive Surgery

目的:采用前瞻性随机对照临床研究,考察对高血压基底节脑出血患者经微创术治疗后再经不同用药方案治疗后的临床效果。方法:150例新发的高血压性脑出血患者随机分为3组,每组50例。经颅内血肿微创清除术治疗后,NGF干预1组:生理盐水2m L/d,颅内注射;4d后改为NGF(Nerve Growth Factor,注射用鼠神经生长因子)2m L/d,肌肉注射。NGF干预2组:神经生长因子2m L/d,颅内注射;4d后改为神经生长因子2m L/d,肌肉注射。对照观察组:生理盐水2m L/d,颅内注射;4d后改为注射用水2m L/d,肌肉注射。3组疗程均为14d。考察患者经治疗后的GCS评分、神经功能、日常生活能力、临床疗效以及预后(致残率、病死率)。结果:治疗后14d,3个组GCS评分均较其治疗前有显著性改善(P<0.05),3个组间比较的差异有统计学意义(P<0.05)。治疗后6个月,3个组BI指数均较其治疗前有明显改善(P<0.05),3个组间比较的差异有统计学意义(P<0.05)。治疗后6个月,3个组NIHSS神经功能评分的比较,差异有统计学意义(P<0.05);NGF干预1组、2组和观察对照组总有效率分别为82.0%(41/50)、96.0%(48/50)和74.0%(37/50),其中NGF干预2组的总效率更高(P<0.05)。治疗后12个月,全部患者中119例(79.33%)致残,其中NGF干预2组的致残率(78.0%)更低(P<0.05);而全部患者中96例(64.0%)患者死亡,3个组的差异无统计学意义(P>0.05)。结论:神经生长因子能显著改善高血压性脑出血患者微创清除术后的GCS评分、神经功能和日常生活能力,且明显降低致残率,其临床效果或与用药剂量等因素有关。

Objective： To investigate the clinical effect after treatment of different regimens in patients with hypertensive basal ganglia hemorrhage after minimally invasive treatment. Methods： 150 cases of patients with hypertensive cerebral hemorrhage of new onset were randomly divided into 3 groups,there were 50 cases in each group. After treatment of minimally invasive removal of intracranial hemorrhage,patients were accepted with different drug regimens. No.1 NGF intervention group： intracranial injection with saline,2m L / d; 4d later,NGF（ nerve growth factor,mouse nerve growth factor for injection 2m L / d）,intramuscular injection.No.2 NGF intervention group： nerve growth factor,2m L / d,intracranial injection; 4d later,nerve growth factor,2m L / d,intramuscular injection. Control observation group： normal saline,2m L / d,intracranial injection; 4d later,the injection of water,2m L / d,muscle injection. The course of treatment was all 14 d in 3groups. The GCS score,neurological function,daily life ability,clinical efficacy after treatment and prognosis of patients were investigated. Results： After treatment of 14 d,the GCS scores of 3 groups were significantly improved than the treatment before（ P〈0.05）,and the difference among the 3 groups was statistically significant（ P〈0.05）. 6 months after treatment,the BI index of the 3 groups were significantly improved than the treatment before（ P〈0.05）,there was significant difference among the 3 groups（ P〈0.05）. After 6 months of treatment,the difference of NIHSS score in 3 groups was statistically significant（ P〈0.05）; in No.1 NGF intervention group,No.2 NGF intervention group and control group,the total effective rate was respectively 82.0%,96%（ 48 / 50） and 74.0%（ 37 / 50）,the total efficiency in No.2 NGF intervention group was more higher（ P〈0.05）. 12 months after treatment,in all patients of 119 cases there was 79.33% patients of disability,and in No.2 NGF intervention group the rate of morbidity（ 78.0%） was more lower（ P〈0.05）; in all96 cases,there was 64.0% patients of died,the differences among the 3 groups had no statistical significance（ P〈0.05）. Conclusion： NGF can significantly improve the GCS score,neurological function and activities of daily living（ ADL） in patients of hypertensive cerebral hemorrhage with minimally invasive removal after operation,and significantly reduce the morbidity rate,the clinical effect is related to the drug dosage.