经额锁孔血肿清除术治疗脑室出血的疗效及炎症因子表达

The inflammatory expression and therapeutic effect research in Key-hole craniotomy hematoma clearance treating intraventricular hemorrhage

目的探讨经额锁孔血肿清除术治疗原发性脑室出血手术前后炎症因子表达及临床疗效。方法选取我院神经外科2011年1月~2015年12月收治的原发性脑室出血患者68例,根据手术方式不同分为观察组和实验组两组,每组各34例,对照组采用双侧侧脑室钻孔引流术,试验组采用经额锁孔血肿清除术;于术前、术后1、2、3d、1、2w采集患者静脉血标本检测肿瘤坏死因子a(Tumer Necrosis Factor,TNF-a)及C-反应蛋白(C-Reaction Protein,CRP),同时观察术后临床疗效。结果两组患者术后TNF-a的表达均较术前降低,术后第3d试验组与对照组比较,差异有统计学意义(P<0.05);两组患者术后CRP的表达均较术前降低,术后第3d、1w试验组与对照组比较,差异有统计学意义(P<0.05);两组患者术后颅内再次出血、肺部感染、尿路感染发病率差异不显著(P>0.05);术后试验组脑积水的发生率低于对照组(P<0.05),两组患者引流管留置时间、颅内感染发生率、意识恢复时间、ICU住院天数比较差异无统计学意义(P>0.05);术后两组患者格拉斯哥预后评分(GOS)差异无统计学意义(P>0.05)。结论原发性脑室出血后采用经额锁孔血肿清除术及双侧脑室钻孔引流术均能明显降低体内炎症反应,两组患者术后并发症发生率及临床疗效无明显差异;但经额锁孔血肿清除术组患者术后脑积水发生率明显低于双侧脑室钻孔引流组。

Objective To explore the inflammatory expression and therapeutic effect in keyhole craniotomy hematoma clearance treating primary intraventricular hemorrhage. Methods 68 patients of intraventricular hemorrhage in my department from January 2011 to December 2015 were divided into experiment group and control group, depending on the operation style. The control group was operated through Frontal transcortical approach. The experiment group was operated through key-hole craniotomy hematoma clearance. The inflammatory factor and the therapeutic effect were observed. Results TNF-α expressions reduced after the operation. 3d after operation, TNF-α expression in experimental group wass better than that in control group （P〈0.05）. CRP xpressions reduced after the operation. 3d and 1W after operation, CRP expression in experimental group was better than that in control group （P〈0.05）. Intracranial hemorrhage, Pulmonary infection and Uranary tract infection between the two group had no defferencev（P〉0.05）. Hydrocephalus in experiment group was better than that in control group （P〈0.05）. The Duration of drainage tube, Incidence of intracranial infection, Recovery time of consciousness and ICU hospitalized daysbetween the two groups have no defference （P〉 0.05）. GOS between the two groups has no defference （P〉0.05）. Conclusion Intraventricular hemorrhage is the mysterious illness which has bad prognosis. The operation style should depend on the patients＇ specific situation and the family＇ will.