高血压脑出血患者微创术后颅内压水平监测及其与神经损伤、炎症应激反应的相关性分析

Monitoring of intracranial pressure in patients with hypertensive intracerebral hemorrhage after minimally invasive surgery and its correlation with nerve injury, inflammatory stress response

目的探讨高血压脑出血患者微创术后颅内压水平监测及其与神经损伤、炎症应激反应的相关关系。方法选取2014年12月至2017年10月台州市立医院收治的高血压脑出血患者60例为研究对象，根据治疗预后分为血肿清除组45例、再出血组15例。比较两组患者的术后24 h颅内压水平、血清神经损伤相关指标[神经元特异性烯醇化酶（NSE）、脑钠肽（BNP）、心脏型脂肪酸结合蛋白（h-FABP）、胶质纤维酸性蛋白（GFAP）、S100B蛋白（S100B）]、炎性介质[白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）]、氧化应激指标[超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、活性氧（ROS）、晚期蛋白氧化产物（AOPP）]含量的差异。采用Pearson检验评估高血压脑出血患者微创术后24 h颅内压水平与神经损伤、炎症应激反应的相关关系。结果血肿清除组患者术后24 h的颅内压[（349.27±45.81）mmH2O]低于再出血组[（511.09±57.64）mmH2O]（t＝－11.093，P〈0.05）；血清中神经损伤标志物NSE、h-FABP、GFAP、S100B的含量[（9.37±1.05）ng/L、（7.04±0.85）μg/L、（7.19±0.85）μg/L、（20.47±3.19）ng/L]均低于再出血组[（14.58±1.62）ng/L、（11.36±1.62）μg/L、（16.23±1.72）μg/L、（45.87±5.62）ng/L）]（t＝－14.414、－13.330、－26.989、－21.749，均P〈0.05），BNP的含量为（22.61±2.85）μg/L高于再出血组的（15.28±1.79）μg/L（t＝11.732，P〈0.05）；血清中炎性介质IL-1β、IL-6、TNF-α的含量[（5.28±0.59）ng/L、（9.73±1.54）ng/L、（15.28±1.76）ng/L]均低于再出血组[（11.07±1.63）ng/L、（20.46±2.95）ng/L、（23.51±3.79）ng/L]（t＝－20.410、－18.225、－11.445，均P〈0.05）；血清中抗氧化因子SOD、CAT的含量[（49.58±6.21）U/L、（68.11±7.59）U/L]均高于再出血组[（32.16±4.05）U/L、（45.23±5.61）U/L]（t＝10.138、10.715，均P〈0.05），氧化因子ROS、AOPP的含量[（15.28±1.73）μg/L、（10.94±1.62）μg/L]均低于再出血组[（34.19±4.25）μg/L、（22.53±2.18）μg/L]（t＝－24.632、－21.945，均P〈0.05）。Pearson检验显示，高血压脑出血患者术后24 h颅内压水平与神经损伤、炎症应激反应程度均呈正相关（r＝0.371、0.483、0.427、0.519、0.537，均P〈0.05）。结论高血压脑出血微创术后颅内压水平监测可有效判断患者神经损伤、炎症应激反应严重程度，预估再发脑出血风险。

Objective To monitor the intracranial pressure in patients with hypertensive intracerebral hemorrhage after minimally invasive surgery and to explore its correlation with nerve injury, inflammatory stress response.Methods From December 2014 to October 2017, 60 patients of hypertensive intracerebral hemorrhage underwent minimally invasive surgery in Taizhou Municipal Hospital were chosen in the research.According to the prognosis, the patients were divided into hematoma clearance group （n=45） and rebleeding group（n=15）. The levels of intracranial pressure 24h after surgery, serum contents of nerve injury related indicators, inflammatory mediators and oxidative stress indicators were compared between the two groups.Pearson test was used to evaluate the correlation between intracranial pressure 24h after surgery and nerve injury, inflammatory stress response.Results 24 h after surgery, the intracranial pressure in the hematoma clearance group was （349.27±45.81）mmH2O, which was lower than （511.09±57.64）mmH2O in the rebleeding group （t=-11.093, P〈0.05）. The serum contents of nerve injury markers such as NSE, h-FABP, GFAP, S100B in the hematoma clearance group were （9.37±1.05）ng/L, （7.04±0.85）μg/L, （7.19±0.85）μg/L, （20.47±3.19）ng/L, respectively, which were significantly lower than those in the rebleeding group [（14.58±1.62）ng/L, （11.36±1.62）μg/L, （16.23±1.72）μg/L, （45.87±5.62）ng/L]（t=-14.414, -13.330, -26.989, -21.749, all P〈0.05）, the BNP level of the hematoma clearance group [（22.61±2.85）μg/L] was significantly higher than （15.28±1.79）μg/L in the rebleeding group （t=11.732, P〈0.05）. The levels of inflammatory mediators such as IL-6, IL-1β, TNF-α in the hematoma clearance group were （5.28±0.59）ng/L, （9.73±1.54）ng/L, （15.28±1.76）ng/L, respectively, which were lower than those in the rebleeding group [（11.07±1.63）ng/L, （20.46±2.95）ng/L, （23.51±3.79）ng/L] （t=-20.410, -18.225, -11.445, all P〈0.05）. The levels of antioxidant factors such as SOD, CAT in the hematoma clearance group were （49.58±6.21）U/L, （68.11±7.59）U/L, respectively, which were significantly higher than those in the rebleeding group [（32.16±4.05）U/L, （45.23±5.61）U/L] （t=10.138, 10.715, all P〈0.05）. The contents of ROS, AOPP in the hematoma clearance group were （15.28±1.73）μg/L, （10.94±1.62）μg/L, respectively, which were lower than those in the rebleeding group [（34.19±4.25）μg/L, （22.53±2.18）μg/L]（t=-24.632, -21.945, all P〈0.05）. Pearson test showed that the level in 24h intracranial pressure in patients with hypertensive intracerebral hemorrhage was positively correlated with the degree of nerve injury, inflammation stress（r=0.371, 0.483, 0.427, 0.519, 0.537, all P〈0.05）.Conclusion Monitoring of intracranial pressure after minimally invasive surgery for hypertensive intracerebral hemorrhage, can effectively judge the severity of nerve injury and inflammatory stress reaction, and can predict the risk of recurrent intracerebral hemorrhage.