局部亚低温联合微创锥颅脑内血肿穿刺引流术对高血压脑出血患者术后血清MMP-9、PCT水平变化及NIHSS评分的影响

Effects of local mild hypothermia combined with minimally invasive puncture and drainage for traumatic brain hematoma on serum levels of MMP-9 and PCT and NIHSS score in patients with hypertensive cerebral hemorrhage

目的 探讨局部亚低温联合微创锥颅脑内血肿穿刺引流术对高血压脑出血（HCH）患者术后血清基质金属蛋白酶-9（MMP-9）、降钙素原（PCT）水平变化及神经功能的影响。方法 选取2014年1月至2017年5月本院92例HCH患者，按照随机数字表法分为观察组（n=46）与对照组（n=46）。两组均于入院后行微创锥颅脑内血肿穿刺引流术，术后给予抗感染、降低颅内压、脱水等常规治疗，观察组在此基础上联合局部亚低温治疗。对比两组手术前及术后7 d神经功能缺损程度（NIHSS）评分、血清MMP-9、PCT水平，术后随访3个月，对比两组预后情况、手术前及术后3个月生活质量（SF-36）评分。结果 （1）神经功能：两组NIHSS评分手术前比较差异无统计学意义（P＞0.05），术后7 d较手术前均有改善（P＜0.05），且观察组低于对照组（P＜0.05）；（2）血清MMP-9、PCT水平：两组血清MMP-9、PCT水平手术前比较差异均无统计学意义（均P＞0.05），术后7 d较手术前均显著改善（均P＜0.05），且观察组低于对照组（均P＜0.05）；（3）预后：术后3个月，观察组预后情况优于对照组（P＜0.05）；（4）生活质量：两组SF-36评分手术前比较差异无统计学意义（P＞0.05），术后3个月较手术前均显著改善（均P＜0.05），且观察组高于对照组（P＜0.05）。结论 局部亚低温联合微创锥颅脑内血肿穿刺引流术治疗HCH疗效显著，可有效减轻患者神经功能缺损程度、降低血清MMP-9及PCT水平，有利于改善预后及生活质量。

Objective To investigate the effects of local mild hypothermia combined with minimally invasive puncture and drainage for traumatic brain hematoma on serum levels of matrix metalloproteinase-9(MMP-9)and procalcitonin(PCT)and NIHSS score in patients with hypertensive cerebral hemorrhage(HCH).Methods 92 patients with HCH treated at our hospital from January,2014 to May,2017 were randomly divided into an observation group(n=46)and a control group(n=46).The two groups received minimally invasive puncture and drainage for traumatic brain hematoma after admission and conventional treatment,such as antiinfection,reduction of intracranial pressure,and dehydration.Then the observation group were treated with local mild hypothermia.The neurologic impairment degree(NIHSS)score and serum levels of MMP-9 and PCT were compared between the two groups before and 7 d after the operation.Both groups were followed up for 3 months;the prognosis and the quality of life(SF-36)score before and 3 months after the operation were compared between the two groups.Results There was no statistical difference in NIHSS score between the two groups(P>0.05);7 d after the operation,the NIHSS scores of two groups were improved(P<0.05)and the NIHSS score of the observation group was lower than that of the control group(P<0.05).There were no statistical differences in the serum levels of MMP-9 and PCT levels between the two groups before the operation;7 d after the operation,the serum levels of MMP-9 and PCT were significantly improved in the two groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).3 months after the operation,the prognosis of the observation group was better than that of the control group(P<0.05).There was no statistical difference in the SF-36 score between the two groups before the operation(P>0.05);3 months after the operation,the SF-36 scores were significantly improved in the two groups(P<0.05)and was higher in the observation group than in the control group(P<0.05).Conclusion Local mild hypothermia combined with minimally invasive puncture and drainage for traumatic brain hematoma in the treatment of HCH is effective and can effectively reduce the degree of neurologic impairment,decrease the serum levels of MMP-9 and PCT,and improve the patients’prognosis and quality of life.