神经导航指引下显微外科手术治疗高血压脑干出血的疗效分析

Efficacy analysis of neuronavigation guided microsurgery in treatment of hypertensive brainstem hemorrhage

目的比较保守治疗与神经导航导引下显微外科手术治疗高血压脑干出血(HBH)的临床效果。方法回顾性分析74例HBH患者的临床资料,分为对照组(保守治疗)和观察组(手术治疗),各37例。比较各组治疗后的临床疗效;比较各组治疗前、治疗后第30 d血清IL-6、NSE水平;比较各组治疗前、治疗后第1 d、半个月、1个月神经功能缺损评分(NDS);比较各组治疗6个月后的格拉斯哥预后(GOS)评分(4~5分为预后良好,1~3分为预后不良)。结果两组治疗后1个月内,观察组死亡10例,对照组死亡25例,观察组治疗后1月内的总有效率(67.57%),高于对照组(27.03%),具有统计学差异(均P<0.01)。两组患者血清IL-6、NSE表达水平在治疗后的第30 d表达水平较治疗前下降,其中观察组中IL-6、NSE表达水平要低于对照组,均有统计学差异(均P<0.05)。与治疗前比,两组在治疗后半个月、1个月NDS评分逐渐降低,但随着时间的延长观察组的评分明显低于对照组,具有统计学差异(均P<0.05)。在治疗1个月后随访结果发现对照组GOS预后良好率(11%,1/10),低于观察组(56%,14/25)。结论神经导航导引下的显微外科手术治疗HBH具有显著的临床价值。

Objective To compare the clinical effect of conservative treatment and neuronavigation guided microsurgery in the treatment of hypertensive brainstem hemorrhage(HBH).Methods The clinical data of 74 HBH patients were analyzed retrospectively.The patients were divided into control group(conservative treatment)and observation group(minimally invasive drainage treatment),37 cases in each group.The clinical efficacy of each group was compared.The levels of serum IL-6 and NSE were compared before and 30 days after treatment.The neurological deficit scores were compared before treatment and in the first day,half month and one month after treatment.The Glasgow outcome score(GOS)after 6 months of treatment was further compared.GOS score of 4-5points was good prognosis,and 1-3 points was poor prognosis.Results After 1 month of treatment,10 cases died in the observation group and 25 in the control group.The total effective rate of the observation group after treatment(67.57%)was significantly higher than that of the control group(27.03%),with the difference was statistically significant(all P<0.01).Compared with before treatment,the levels of serum IL-6 and NSE in the two groups decreased on the 30th day after treatment,and the observation group was lower than the control group,and the difference was statistically significant(all P<0.05).Compared with before treatment,NDS scores of two groups decreased gradually after half a month and one month after treatment,but with the extension of time,the score of observation group was significantly lower than that of control group,and the difference was statistically significant(all P<0.05).One month after treatment,the results of follow-up showed that the good prognosis rate of GOS in the control group(11%,1/10)was significantly lower than that in the observation group(56%,14/25).Conclusion Neuronavigation guided microsurgery has significant clinical value in the treatment of HBH.