小骨窗显微手术在老年高血压脑出血患者中的应用效果及对其神经功能和血清S100B、NSE、BDNF水平的影响

Application effect of small bone window microsurgery in elderly patients with hypertensive intracerebral hemorrhage and its effect on neurological function and serum levels of S100B,NSE and BDNF

目的探讨小骨窗显微手术治疗老年高血压脑出血(HICH)的疗效及对患者神经功能和血清S100B、神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)水平的影响。方法回顾性选入2019年1月至2022年1月临汾市中心医院收治的老年HICH患者122例,并根据治疗方法不同分为对照组(61例,传统大骨瓣开颅血肿清除术)和观察组(61例,小骨窗显微手术)。评价两组的手术情况、神经功能以及血清S100B、NSE、BDNF水平变化以及临床疗效,并进行统计学比较。结果观察组手术时间、皮层切口长度、术中出血量、术后意识恢复时间、住院天数及并发症发生率均显著低于对照组,差异均有统计学意义(P<0.05),而两组血肿清除率差异无统计学意义(P>0.05)。观察组术后7、14、30 d的中国脑卒中临床神经功能缺损程度评分量表(CSS)评分明显低于对照组,术后6个月的Barthel指数(BI)显著高于对照组,差异均有统计学意义(P<0.05)。观察组术后30 d血清S100B和BDNF水平显著高于对照组,NSE水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗总有效率明显高于对照组(85.25%vs.67.21%),差异有统计学意义(P<0.05)。结论对于老年HICH患者,小骨窗显微手术与传统大骨瓣开颅术在血肿清除率方面效果相当,但前者手术时间短、创伤小、术后恢复快、并发症少,且在调节血清S100B、NSE、BDNF水平、促进神经功能恢复等方面具有优势。

Objective To investigate the application effect of small bone window microsurgery in elderly patients with hypertensive intracerebral hemorrhage(HICH)and its effect on neurological function and serum levels of S100B,neuron specific enolase(NSE)and brain-derived neurotrophic factor(BDNF).Methods A total of 122 elderly patients with HICH who were treated in Linfen Central Hospital from January 2019 to January 2022 were retrospectively selected and divided into control group(61 cases,traditional large bone flap craniotomy for hematoma removal)and observation group(61 cases,small bone window microsurgery)according to different treatment methods.The clinical efficacy,neurological function and serum S100B,NSE,BDNF levels were compared between the two groups.Results The operation time,the length of cortical incision,the amount of intraoperative bleeding,the time of postoperative consciousness recovery,the length of hospitalization and the incidence of complications in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05),while there was no significant difference in the clearance rate of hematoma between the two groups(P>0.05).The Chinese stroke scale of clinical neurologic deficit grade(CSS)scores of the observation group at 7,14 and 30 days after operation were significantly lower than those of the control group,and the Barthel index(BI)at 6 months after operation was significantly higher than that of the control group,the differences were statistically significant(P<0.05).The levels of serum S100B and BDNF in the observation group at 30 days after operation were significantly higher than those in the control group,and the level of NSE was significantly lower than that in the control group,the differences were statistically significant(P<0.05).And the total effective rate of treatment was significantly higher than that in the control group(85.25%vs.67.21%),the difference was statistically significant(P<0.05).Conclusion For elderly HICH patients,small bone window microsurgery and traditional large bone flap craniotomy have the same effect in the clearance rate of hematoma,but the former has the advantages of short operation time,small trauma,fast postoperative recovery and less complications,which has advantages in regulating serum S100B,NSE,BDNF levels,promoting nerve function recovery,etc.