开颅血肿清除术对高血压脑出血破入脑室的疗效及血脑屏障功能的影响

Application of Hematoma Evacuation Combined with External Ventricular Drainage in Hypertensive Cerebral Hemorrhage and Its Effect on Blood-brain Barrier Function

目的:探讨开颅血肿清除(HE)联合脑室外引流(EVD)术对高血压脑出血(HICH)患者的疗效及血脑屏障功能的影响。方法:根据手术方案将76例HICH破入脑室患者均分为研究组和对照组,对照组行EVD治疗,研究组行EVD联合开颅HE治疗,术后随访6个月;比较2组患者术后术后死亡率、术后在重症监护室(NICU)治疗时间、术后并发症、手术前和术后第14天时的格拉斯哥昏迷评分(GCS)变化(ΔGCS)、术后6个月时格拉斯哥预后评分(GOS)及改良Rankin量表(m RS)评分,比较术前和术后第14天时血清N末端脑钠肽前体(NT-pro BNP)、高迁移率族蛋白1(HMGB-1)水平、脑脊液和血清白蛋白(ALB)水平及血脑屏障(BBB)指数。结果:2组患者术后死亡率、NICU治疗时间及术后并发症发生率比较,差异无统计学意义(P>0.05);研究组ΔGCS评分、术后6个月时的GOS评分均明显高于对照组,术后6个月m RS评分低于对照组(P<0.05);术前两组患者血清NT-pro BNP、HMGB-1、ALB及脑脊液ALB水平和BBB指数比较,差异无统计学意义(P>0.05);两组患者术后第14天时血清NT-pro BNP、HMGB-1水平均较术前降低,研究组降低更明显(P<0.05);脑脊液ALB水平及BBB指数均较术前明显升高,对照组升高更明显(P<0.05),但血清ALB水平比较,差异无统计学意义(P>0.05)。结论:EVD联合HE治疗HICH破入脑室患者的疗效优于单独EVD治疗,更能促进患者血脑屏障功能的恢复。

Objective： To investigate the application of hematoma evacuation （HE） combined with external ventricular drainage （EVD） in the rupture of ventricles of hypertensive intracerebral hemor- rhage （HICH） and analyze its effect on the function of the blood-brain barrier. Methods： Totally 76 cases with HICH rupture ventricle were divided into the study group （n = 38 ） and the control group （n =38） according to the surgical plan. The control group underwent simple EVD treatment, and the study group also had craniotomy HE treatment. Both groups were followed up for 6 months after treat- ment. The curative effect and complications of the 2 groups were compared, Serum NT-proBNP and HMGB-1 levels were measured before and after surgetT. Cerebrospinal fluid and serum albumin levels were measured and the blood-brain barrier （BBB） index was calculated. Results： During hospital stay, there was no significant difference of the death rate in the 2 groups （P 〉 0.05 ） ; The 14th d postoperative GCS score and 6 months postoperative GOS score in the study group were higher than those of the control group. The 6 months postoperative mRS score was lower than that of the control group （P 〈 0.05）. The serum NT-proBNP and HMGB-1 on the 14th day after operation decreased compared with the preoperative serum index, and such decrease of serum in the study group was more obvious （P 〈 0. 05 ）, Cerebrospinal fluid albumin content and BBB index in 2 groups were higher than those before operation （P 〈0.05 ）, and the study group＇s were higher than control group＇s （P 〈 0.05 ）. Conclu- sion ： Compared with the single therapy of EVD, HE combined with EVD can reduce the degree of inflammatory reaction and nerve injury in patients with HICH broken into ventricles. It can also promote the recovery of blood-brain barrier function.