微创下置管抽吸液化引流手术治疗脑出血的临床效果及对神经功能、炎性因子水平的影响

Clinical effect of minimally invasive surgical treatment of cerebral hemorrhage by minimally invasive catheter suction and drainage influence on nerve function and inflammatory cytokines levels

目的 观察脑出血患者应用微创下置管抽吸液化引流手术的效果及对神经功能、炎性细胞因子水平的影响。方法 选择2015年1月—2016年1月西安长安医院神经外科收治脑出血患者92例作为研究对象,按随机数字表法分为观察组46例和对照组46例。对照组采用内科保守治疗：甘露醇、白蛋白或呋塞米等脱水药物及时降颅压,维持水电解质平衡,严密监测患者生命体征变化情况。观察组在常规治疗基础上行微创钻孔置管血肿抽吸液化引流术。比较2组患者临床疗效、神经功能缺损评分及血清高敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）水平,计算再出血发生率、病死率,观察治疗后并发症发生情况。结果 治疗后观察组总有效率明显升高（91.3%vs.71.7%,χ^2=5.845,P=0.016）;与对照组比较,治疗后1个月、3个月观察组神经功能缺损评分明显降低（t=12.629、11.381,P=0.000、0.000）,血清hs-CRP、TNF-α、IL-6水平降低,病死率明显降低,而再出血发生率明显升高,2组间比较差异均有统计学意义（t=6.685、4.865、7.967、6.183、13.904,P=0.000、0.000、0.000、0.013、0.000）;2组患者均出现尿路感染、肺部感染、消化道出血、静脉血栓形成等并发症,组间比较差异无统计学意义（χ^2=0.199、0.751、0.474、2.224,P=0.655、0.386、0.491、0.136）。结论 微创下置管抽吸液化引流术治疗脑出血患者疗效确切,有效改善神经功能,降低炎性反应,有利于提高患者预后,值得临床推广应用。

Objective To observe the effect of minimally invasive surgery on the patients with cerebral hemorrhage and the effect on the nerve function and the level of inflammatory cytokines in patients with cerebral hemorrhage .Methods Ninety-two cases of patients with intracerebral hemorrhage were selected , which were treated in hospital from January 2015 to January 2016, and they were divided into the study group （46 cases） and control group （46 cases）.The patients of control group were treated with conservative treatment , including mannitol , albumin or furosemide and other dehydration drugs for re-ducing the intracranial pressure , maintain water balance solution , and close monitoring of vital signs of patients .On the basis of the conventional treatment , the patients of study group were treated with minimally invasive drilling catheter hematoma aspi -ration liquefied drainage operation .Compare the clinical efficacy , the incidence of re-bleeding, mortality rate, complications, and changes of neurological function deficit scores ,serum hs-CRP, TNF-α, IL-6 of two groups.Results The patients of the study group got a total efficiency of 91.3%, which was significantly better than the 71.7%of the control group （χ^2 =5.845, P =0.016）;The neurological function deficit scores （ t =12.629、11.381, P =0.000、0.000）,hs-CRP, TNF-α, IL-6, and mortality rate of the study group were significantly less than those of the control group after the treatment （χ^2 =6.685,χ^2 =4.865,χ^2 =7.967, all P 〈0.01）;The incidence of re-bleeding of the study group were significantly higher than those of the control group after the treatment （χ^2 =13.904, P =0.000）;There were urinary tract infection , lung infection, gastrointesti-nal bleeding , venous thrombosis and other complications occurred in patients of all two groups during treatment , but there was no significant difference between the two groups （χ^2 =0.199,χ^2 =0.751,χ^2 =0.474,χ^2 =2.224, all P 〉0.05）.Conclu-sion It demonstrated that treating patients with intracerebral hemorrhage , minimally invasive catheter pumping liquefied drainage operation can get exact clinical efficacy , effectively improve the neurological function , reduce the inflammatory reac-tion, which is help to improve the prognosis of patients , and worthy of clinical application .