小骨窗微创血肿清除术联合甘露醇对高血压脑出血患者炎性因子、血清铁蛋白和血清P物质的影响

Effects of craniotomy with small skull window microsurgical surgery combined with mannitan on inflammatory cytokines,serum ferritin and serum P in patients with hypertensive intracerebral hemorrhage

目的探讨小骨窗开颅微创血肿清除术联合甘露醇对高血压脑出血患者炎性因子、血清铁蛋白和血清P物质的影响。方法选取青岛市中心医院神经外科2015年7月—2017年9月收治的96例高血压脑出血患者。按随机数字表法分为联合组和对照组,其中联合组49例,对照组47例。对照组给予小骨窗开颅微创血肿清除术,观察组在对照组基础上联合甘露醇治疗,疗程1周。对比2组临床疗效、血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血清铁蛋白和P物质水平及中国脑卒中临床神经功能缺损程度评分量表(CSS)评分、蒙特利尔认知评估量表(MoCA)评分。结果联合组患者临床总有效率高于对照组(95.92%vs.85.11%,χ~2=8.131,P<0.05);治疗后联合组患者血肿和水肿体积明显小于对照组(t=8.943,5.482,P均<0.01);2组患者血清hs-CRP、TNF-α、IL-6、P物质水平及CSS量表评分均低于治疗前,MoCA评分和血清铁蛋白水平均高于治疗前(P均<0.01),且联合组患者改善优于对照组(t=7.167、8.600、10.695、13.603、15.413、3.927、6.264,P均<0.01)。结论小骨窗开颅微创血肿清除术联合甘露醇治疗高血压脑出血可获得显著效果,促进神经功能的恢复,降低血清炎性因子水平。

Objective To investigate the effect of small bone window craniotomy with minimally invasive hematoma and mannitol on inflammatory cytokines,serum ferritin and serum P in patients with hypertensive intracerebral hemorrhage.Methods Ninety-six patients with hypertensive intracerebral hemorrhage admitted in our hospital from July 2015 to September2017 were enrolled. They were divided into a combination group and a control group by a random number table method, 49 cases in the combined group and 47 cases in the control group. The control group was given minimally invasive craniotomy with hematoma. The observation group was treated with mannitol on the basis of the control group. The clinical efficacy, serum high sensitivity C reactive protein（hs-CRP）, tumor necrosis factora（TNF-α）, interleukin 6（IL-6）, ferritin, and serum P substance levels, and the clinical outcomes of stroke in China Neurological deficit rating scale（CSS） score, Montreal cognitive assessment scale（MoCA） score in the two groups were compared. Results The total effective rate in the combined group was 95.92%, which was higher than that in the control group of 85.11%（χ^2=8.131, P0.05）; the volume of hematoma and edema was significantly smaller in the combined group than in the control group（t=8. 943, t =5.482, P〈0. 01）; Serum hs-CRP, TNF-a, IL-6 and substance P levels and CSS scale scores were lower in both groups than before treatment, and MoCA scores and serum ferritin levels were higher than before treatment（P〈0. 01）, and patients in the combined group improved better than the control group（t = 7. 167,t=8. 600, t = 10. 695, t = 13. 603, t=15.443, t = 3. 927, t =6.264, P〈0. 01）. Conclusion Small bone window craniotomy minimally invasive hematoma removal combined with mannitol treatment of hypertensive intracerebral hemorrhage can obtain significant effect, promote the recovery of neurological function, reduce serum levels of inflammatory cytokines.