微创穿刺引流术联合依达拉奉治疗高血压脑出血的效果及对患者神经功能的影响

Clinical efficacy and neurological effect of minimally invasive puncture and drainage combined with edaravone on hypertensive intracerebral hemorrhage

目的探讨微创穿刺引流术联合依达拉奉治疗高血压脑出血(HICH)患者的效果及对神经功能的影响。方法选取2015年1月至2017年12月青海省人民医院收治的100例HICH患者为研究对象,按照随机数字表法分为对照组和观察组,各50例。对照组采用微创穿刺引流术治疗;观察组在对照组基础上给予依达拉奉治疗。比较2组患者临床疗效、治疗前和治疗14 d后脑血肿和脑水肿体积、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、脑卒中患者临床神经功能缺损程度量表(CSS)评分和日常生活活动能力量表(ADL)评分及血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)及C反应蛋白(CRP)含量。结果观察组患者治疗总有效率明显高于对照组[86. 0%(43/50)比60. 0%(30/50)],差异有统计学意义(P=0. 015)。治疗后,2组患者脑血肿和脑水肿体积均明显低于治疗前,且观察组明显低于对照组[(10. 4±1. 4)ml比(16. 2±1. 6)ml、(1. 2±0. 5)ml比(2. 1±0. 7) ml];2组患者NIHSS评分和CSS评分均明显低于治疗前,且观察组明显低于对照组[(20. 1±1. 7)分比(23. 5±1. 5)分、(9. 1±1. 1)分比(12. 2±1. 0)分],GCS评分和ADL评分均明显高于治疗前,且观察组明显高于对照组[(4. 9±0. 5)分比(4. 0±0. 4)分、(66±6)分比(44±5)分];2组患者血清IL-6、TNF-α及CRP水平均明显低于治疗前,且观察组明显低于对照组[(43±6) ng/L比(75±7) ng/L、(38±5) ng/L比(54±6) ng/L、(10. 2±1. 4)mg/L比(19. 5±1. 3)mg/L],差异均有统计学意义(均P <0. 05)。结论微创穿刺引流术联合依达拉奉治疗HICH患者的临床效果较好,可有效促进患者神经功能恢复,提高患者生活质量。

Objective To explore the therapeutic effect of minimally invasive puncture and drainage combined with edaravone on hypertensive intracerebral hemorrhage( HICH) and its influence on neurological function. Methods Totally 100 patients with HICH admitted to Qinghai Provincial People’s Hospital from January2015 to December 2017 were randomly divided into control group and observation group,with 50 cases in each group. The control group was treated with minimally invasive puncture and drainage. The observation group was treated with minimally invasive puncture and drainage combined with edaravone. Clinical efficacy,cerebral hematoma and edema volume before and 14 d after treatment,scores of National Institutes of Health Stroke Scale(NIHSS),Glasgow Coma Scale(GCS),Chinese Stroke Scale(CSS) and Activity of Daily Living(ADL),levels of serum interleukin-6( IL-6),tumor necrosis factor-α( TNF-α) and C-reactive protein( CRP) were analyzed.Results The total effective rate in observation group was significantly higher than that in control group[86. 0%(43/50) vs 60. 0%(30/50)](P = 0. 015). After treatment,cerebral hematoma and edema significantly reduced in both groups;the volumes in observation group were significantly lower than those in control group[(10. 4 ± 1. 4)ml vs(16. 2 ± 1. 6)ml,(1. 2 ± 0. 5)ml vs(2. 1 ± 0. 7)ml](P < 0. 05). After treatment,NIHSS score and CSS score in both groups were significantly lower than those before treatment;NIHSS score and CSS score in observation group were significantly lower than those in control group[(20. 1 ± 1. 7) vs(23. 5 ± 1. 5),(9. 1 ± 1. 1) vs(12. 2 ± 1. 0)];GCS score and ADL score were significantly higher than those before treatment;GCS score and ADL in observation group were significantly higher than those in control group [( 4. 9 ± 0. 5) vs(4. 0 ± 0. 4),(66 ± 6) vs(44 ± 5)](P < 0. 05). After treatment,serum levels of IL-6,TNF-α and CRP in both groups were significantly lower than those before treatment;the levels in observation group were significantly lower than those in control group[(43 ± 6)ng/L vs(75 ± 7)ng/L,(38 ± 5)ng/L vs(54 ± 6) ng/L,(10. 2 ± 1. 4) mg/L vs(19.5 ±1.3)mg/L](all P <0. 05). Conclusion Minimally invasive puncture and drainage combined with edaravone treating HICH can effectively promote the recovery of neurological function and improve the quality of life.