立体定向软通道血肿清除术治疗高血压脑出血的疗效及对患者神经功能、炎性因子的影响

Effect of stereotactic soft channel hematoma removal on neurological function and inflammatory factor in patients with hypertensive cerebral hemorrhage

目的:观察立体定向软通道血肿清除术对高血压脑出血(HICH)患者的疗效及对神经功能、炎性因子的影响。方法:纳入2016年8月至2017年4月河北省邯郸市第一医院收治的82例HICH患者为研究对象,按随机数字表法分为观察组和对照组,每组41例。对照组予以常规开颅手术治疗,观察组接受立体定向软通道血肿清除术治疗。采用美国国立卫生研究院卒中量表(NIHSS)评估患者术前及术后7d、14d、1个月、3个月、6个月神经功能恢复情况,观察手术前、后血清肿瘤坏死因子(TNF)-α、C-反应蛋白(CRP)、降钙素原(PCT)变化,并对比两组治疗期间并发症发生情况及预后。结果:两组术后7d、14d、1个月、3个月、6个月NIHSS评分均显著低于术前,且观察组术后不同时点NIHSS评分显著低于对照组(P<0.05)。观察组肺部感染、消化道出血、再发脑出血、应激性溃疡发生率明显低于对照组(P<0.05)。两组术后CRP、PCT水平显著低于术前(P<0.05),TNF-α水平显著高于术前(P<0.05),观察组术后CRP、PCT、TNF-α水平显著低于对照组(P<0.05)。观察组预后良好率为80.49%,显著高于对照组的58.54%(P<0.05)。结论:立体定向软通道血肿清除术治疗HICH临床疗效确切,能有效缓解患者神经受损程度,控制炎性指标,改善患者预后,且安全性较好。

Objective:To observe the effect of stereotactic soft channel hematoma removal on neurological function and inflammatory factors in patients with hypertensive intracerebral hemorrhage(HICH).Methods:82 HICH patients treated in our hospital from August 2016 to April 2017 were divided into an observation group and a control group,with 41 cases in each group.The patients in the control group were treated with conventional craniotomy,and those in the observation group were treated with stereotactic soft channel hematoma clearance.The national institutes of health stroke scale(NIHSS)was used to assess the nerve function before operation and 7 d,14 d,1 month,3 month and 6 months after operation.The serum levels of tumor necrosis factor(TNF)-α,C-reactive protein(CRP)and calcitonin(PCT)were detected.The incidence of complications and prognosis were compared.Results:The NIHSS score in the observation group was significantly lower than that in the control group after 7 d,14 d,1 month,3 month and 6 months of operation(P<0.05).The incidence of pulmonary infection,gastrointestinal hemorrhage,recurrent cerebral hemorrhage and stress ulcer in the observation group was significantly lower than that in the control group(P<0.05).The CRP and PCT levels in both groups were significantly decreased after operation while TNF-αlevel was increased(P<0.05),and the levels of CRP,PCT and TNF-a in the observation group were lower than those in the control group(P<0.05).The rate of good prognosis was 80.49%in the observation group,which was markedly higher than that in the control group(58.54%)(P<0.05).Conclusion:Stereotactic soft channel hematoma clearance has a significant efficacy for HICH,and it can effectively alleviate nerve damage,reduce inflammatory response,and improve the prognosis of patients.