硬通道微创穿刺引流在老年高血压脑出血患者中的效果及对创伤应激、脑水肿的影响

The Effect of Hard Channel Minimally Invasive Puncture Drainage in Elderly Patients with Hypertensive Cerebral Hemorrhage and Its Impact on Traumatic Stress and Cerebral Edema

目的讨论硬通道微创穿刺引流对老年高血压脑出血患者的治疗效果以及对创伤应激和脑水肿的作用。方法方便选取2018年1月—2022年8月如东县中医院接诊的高血压脑出血患者83例,按照随机数表法将其分为对照组(n=41)和研究组(n=42)。对照组采取保守疗法,研究组采取硬通道微创穿刺引流治疗,对比两组患者治疗前后创伤应激激素水平、脑水肿情况以及日常生活能力指数(Barthel)、神经功能缺损评分(NIHSS)和不良反应发生率以及治疗效果。结果治疗前,两组患者创伤应激指标水平比较,差异无统计学意义(P>0.05);治疗后,研究组患者去甲肾上腺素(NE)、血清中皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血管紧张素Ⅱ(AngⅡ)水平均显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者脑水肿情况比较,差异无统计学意义(P>0.05);治疗后,研究组患者患侧综合扰动系数变动与周围脑水肿体积变动范围较对照组更小,差异有统计学意义(P<0.05)。治疗前,两组患者Barthel和NIHSS比较,差异无统计学意义(P>0.05);治疗后,研究组患者Barthel、NIHSS评分优于对照组,差异有统计学意义(P<0.05)。研究组患者治疗有效率为95.24%,高于对照组的70.73%,差异有统计学意义(χ^(2)=8.885,P<0.05)。结论对老年高血压脑出血患者实施硬通道微创穿刺引流术,可以有效提高其治疗效果,并降低患者脑出血后的创伤应激水平以及脑水肿情况。

Objective To discuss the therapeutic effect of hard channel minimally invasive puncture and drainage on elderly patients with hypertensive cerebral hemorrhage,as well as the effect on traumatic stress and cerebral edema.Methods 83 patients with hypertensive cerebral hemorrhage admitted to Rudong County Traditional Chinese Medicine Hospital from January 2018 to August 2022 were conveniently selected and divided into a control group(n=41)and a study group(n=42)using a random number table method.The control group received conservative treatment,while the study group received hard channel minimally invasive puncture and drainage treatment.The levels of traumatic stress hormones,brain edema,daily living ability index(Barthel),neurological deficit score(NIHSS)of before and after treatment,incidence of adverse reactions,and treatment effects were compared between the two groups of patients.Results Before treatment,there was no statistically significant difference in the level of traumatic stress between the two groups of patients(P>0.05);after treatment,the levels of norepinephrine(NE),serum cortisol(Cor),adrenocorticotropic hormone(ACTH),and angiotensin Ⅱ(AngⅡ)in the study group were significantly lower than those in the control group,the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in brain edema between the two groups of patients(P>0.05);after treatment,the range of changes in the comprehensive disturbance coefficient of the affected side and the volume of peripheral brain edema in the study group was smaller than that of the control group,and the difference was statistically significant(P<0.05).Before treatment,compared between the two groups of patients in Barthel and NIHSS,the difference was not statistically significant(P>0.05);after treatment,the Barthel and NIHSS scores of the study group patients were better than those of the control group,and the difference was statistically significant(P<0.05).The effective rate of treatment in the study group was 95.24%,higher than 70.73% in the control group,and the difference was statistically significant(χ^(2)=8.885,P<0.05).Conclusion Hard channel minimally invasive puncture and drainage for elderly patients with hypertensive cerebral hemorrhage can effectively improve the therapeutic effect and reduce the level of traumatic stress and cerebral edema after cerebral hemorrhage.