动态监测肿瘤坏死因子-α对高血压脑出血术后管理的临床意义

Clinical significance of dynamic monitoring of tumor necrosis factor-α in postoperative management of hypertensive intracerebral hemorrhage

目的探讨动态监测肿瘤坏死因子(TNF)-α对高血压脑出血术后管理的临床意义。方法选取2014年5月至2016年5月饶平县人民医院神经外科收治的68例高血压脑出血术后患者为研究对象。通过随机数字生成器将患者分为对照组和观察组,每组34例。对照组采取高血压脑出血单元术后常规治疗,观察组采用动态监测TNF-α以调整个体化治疗方案,术后连续观察4周。酶联免疫法检测两组患者术前与术后7 d的TNF-α血清浓度水平,比较两组患者治疗前后的症状与体征,观察患者治疗前后症状与体征,采用格拉斯哥昏迷评分(GCS)和脑出血评分进行总体疗效评价;酶联免疫法分别检测两组患者术前与术后7 d血清TNF-α浓度水平;观察两组患者的住院总时长。结果观察组患者的治疗总有效率为88.24%,明显高于对照组的67.65%,差异有统计学意义(P<0.05);治疗后,观察组患者GCS评分为(11.36±2.18)分,明显高于对照组的(10.04±1.42)分,差异有显著统计学意义(P<0.01);对照组患者术后7 d TNF-α浓度为(79.34±21.65)pg/m L,显著高于观察组的(39.28±12.09)pg/m L,差异有显著统计学意义(P<0.01);观察组患者的住院时间为(16.82±5.46)d,明显短于对照组的(21.96±6.32)d,差异有统计学意义(P<0.05)。结论动态监测TNF-α有助于适时调整个体化治疗方案,其不仅能够改善患者的症状和体征,还可以缩短病程,因而适用于高血压脑出血术后管理。

Objective To investigate the clinical significance of dynamic monitoring of tumor necrosis factor-α （TNF-α） in postoperative management of hypertensive intracerebral hemorrhage （HICH）. Methods A total of 68 patients with HICH, who admitted to Department of Neurosurgery of the People＇s Hospital of Raoping County from May, 2014 to May, 2016, were selected and divided into the control group and the observation group, with 34 cases in each group. The control group was treated with the conventional medication of HICH stroke unit, while the observation group was treated with individual treatment plan adjusted by dynamic monitoring of TNF-α, all 4 weeks. The levels of serum TNF-α of the two groups were measured by ELISA before and 7 days after operation. The symptoms and signs of the patients before and after the treatment were observed and compared. Glasgow Coma Scale （GCS） and cerebral hemorrhage score were used to evaluate the overall efficacy. Moreover, the total length of hospital stay was observed. Results The total effective rate of the observation group was 88.24%, which was obviously higher than 67.65% of the control group （P〈0.05）. After the treatment, the score of GCS of the observation group was （11.36±2.18）, which was sig nificantly higher than （10.04± 1.42） of the control group （P〈0.01）. Seven days after the treatment, the serum concentration of TNF-α in the control group was （79.34±21.65） pg/mL, which was significantly higher than （39.28±12.09） pg/mL in the observation group （P〈0.01）. The length of hospitalization of the observation group was （16.82±5.46） d, which was significantly shorter than （21.96±6.32） d of the control group （P〈0.05）. Conclusion Dynamic monitoring of TNF-a can help to timely adjust the individual treatment plan, which can not only improve the patient＇s symptoms and signs, but also shorten the course of the disease. Therefore, the postoperative management of HICH is very applicable.