微创颅内血肿抽吸术对高血压脑出血患者B型脑钠肽、C反应蛋白、同型半胱氨酸及生活质量的影响

The Effect of Minimally Invasive Intracranial Hematoma Aspiration on the BNP CRP,Hcy and Quality of Life in Patients with Hypertensive Cerebral Hemorrhage

目的研究微创颅内血肿抽吸术对高血压脑出血患者B型脑钠肽(BNP)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)及生活质量的影响。方法选取2014年12月至2016年10月湖南中医院大学附属宁乡医院高血压脑出血患者80例,按处理方式分为常规清除组(n=38)和微创抽吸组(n=42),前者给予开颅骨窗血肿清除术治疗,后者给予微创颅内血肿抽吸术治疗,并随访6个月;观察两组美国国立卫生院神经功能缺损评分(national institute of health stroke scale,NIHSS)得分情况;BNP、CRP、Hcy水平(ELISA法);术中出血量、平均手术时间、住院时间、血肿清除率、并发症、死亡情况及治疗前、治疗后1、3、6个月的生活质量(ADL)。结果与常规清除组比较,微创抽吸组治疗前NIHSS得分和BNP、CRP、Hcy水平差异无统计学意义(P>0.05),治疗后,微创抽吸组治疗有效率高于常规清除组(90.48%vs.71.05%),NIHSS得分低于常规清除组,术中出血量、平均手术时间、住院时间和并发症均减少,血肿清除率增加,BNP、CRP、Hcy水平均降低,治疗后1、3、6个月ADL得分均增高,差异有统计学意义(P<0.05);两组病死率差异无统计学意义(P>0.05)。结论微创颅内血肿抽吸术治疗较开颅骨窗血肿清除术,对高血压脑出血患者的神经功能和血肿清除更具改善作用,降低血浆BNP、CRP、Hcy水平,减少并发症,改善其生活质量。

Objective To investigate the effect of minimally invasive intracranial hematoma aspiration on the brain natriuretic peptide （BNP）, C reactive protein （CRP）, and homocysteine （Hcy） and quality of life in patients with hypertensive cerebral hemorrhage. Methods 80 patients with hypertensive cerebral hemorrhage treated in Ningxiang Hospital of Hunan University of Chinese Medicine between December of 2014 and October of 2016 were selected and divided into the conventional removal group （n=38） and minimally invasive aspiration group （n=42） according to the treatment method. The former group received craniotomy in the treatment of bone window hematoma, while the latter group was given the therapy of minimally invasive intracranial hematoma aspiration. Both groups were followed up for 6 months and observed in terms of the score of national institute of health stroke scale （NIHSS）, the levels of plasma BNP, CRP and Hcy （by ELISA）. The other data were also recorded including the amount of intraoperative bleeding, average time of operation, hospitalization time, hematoma clearance rate, complications, mortality, and the quality of life （by ADL） before treatment and 1, 3, and 6 months after treatment respectively. Results There were no significant differences between the two groups in the NIHSS score and the levels of plasma CRP, BNP and Hcy respectively before treatment（P〉0.05）. After treatment, the effective rate of the minimally invasive aspiration group （90.48%） was higher than that of the conventional removal group （71.05%）; The minimally invasive aspiration group had lower NIHSS scores, less amount of intraoperative bleeding, average time of operation, hospitalization time and complications, higher hematoma clearance rate, lower levels of BNP, CRP and Hcy, and higher ADL scores 1, 3 and 6 months after treatment than the conventional removal group respectively, and the differences were statistically significant（P^0.05）. There were no significant differences between the two groups in mortality（P~ 0.05）. Conclusion Compared with the craniotomy in the treatment of skull window hematoma, the minimally invasive intracranial hematoma aspiration is more effective in improving the neurological function and hematoma clearance, lowering the levels of plasma BNP, CRP and Hcy, reducing the complications and improving the quality of life in patients with hypertensive cerebral hemorrhage.