微创置管引流术治疗高血压脑出血疗效分析

Efficacy of minimally invasive catheter drainage surgery for the treatment of hypertensive cerebral hemorrhage

目的探讨微创置管引流术治疗高血压脑出血(HICH)的疗效。方法回顾性分析2016年2月至2017年8月西安市北方医院神经外科HICH患者102例,其中接受微创置管引流术治疗患者34例(研究组),显微手术清除术患者68例(对照组)。比较2组患者手术时间、术中出血量、血肿清除率、术前和术后神经元特异性烯醇化酶(NSE)和可溶性蛋白-100β(S-100β)水平以及术后3个月日常生活能力(ADL)。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果研究组相比对照组手术时间[(2.31±0.83)vs(4.02±1.20)h]和术中出血量[(43.29±9.17)vs(82.28±12.20)ml]减少,血肿清除率[(88.39±9.12)%vs(79.54±10.21)%]增高,差异具有统计学意义(P<0.001)。研究组与对照组术后NSE[(23.05±2.78)vs(22.95±3.12)ng/L]水平、S-100β蛋白[(1.95±0.21)vs(1.88±0.26)ng/L]水平、并发症发生率[14.65%(6/34)vs 17.65%(12/68)]差异无统计学意义(P>0.05)。研究组ADL恢复良好率为90.91%(30/33),对照组ADL恢复良好率为72.73%(48/66),2组差异有统计学意义(P=0.037)。结论微创血肿置管引流治疗HICH疗效好,具有微创、快速、出血少等优点,值得推广。

Objective To evaluate the efficacy of minimally invasive catheter drainage surgery in the treatment of hypertensive intracerebral hemorrhage(HICH). Methods A retrospective analysis was made of 102 HICH patients treated in the Neurosurgery Department of Xi′an Northern Hospital from Feb. 2016 to Aug. 2017, of whom 34(study group) underwent minimally invasive catheter drainage and 68(control group) underwent microsurgical removal. The two groups were compared in the operation time, intraoperative bleeding volume, hematoma clearance rate, preoperative and postoperative neuron-specific enolase(NSE) and soluble protein 100-β(S-100β) levels, and activity of daily living(ADL) at 3 months after operation. SPSS statistics 19.0 was used for data analysis, and Studet′s t test or Chi-square test was used to compare between groups. Results Compared with the control group, the study group had shorter operation time [(2.31±0.83) vs(4.02±1.20)h], lower intraoperative bleeding volume[(43.29±9.17) vs(82.28±12.20)ml], and significantly higher clearance rate of hematoma [(88.39±9.12)% vs(79.54±10.21)%](P<0.001). There was no significant difference in NSE [(23.05±2.78) vs(22.95±3.12)ng/L] and S-100β protein [(1.95±0.21) vs(1.88±0.26)ng/L], and incidence of complications [14.65%(6/34) vs 17.65%(12/68)](P>0.05) between the two groups. The recovery rate of was 90.91%(30/33) in the study group against 72.73%(48/66) in the control group(P=0.037). Conclusion Minimally invasive catheter drainage surgery is effective for HICH and is worth popularizing for its minimal invasiveness, speed and less bleeding.