神经内镜血肿清除术联合置管引流对HICH脑室破入患者预后的影响

Effects of Neuroendoscopic Hematoma Removal Combined with CatheterDrainage on Prognosis of Patients with HICH Ventricle Rupture

目的 探讨神经内镜血肿清除术联合置管引流对高血压性脑出血(HICH)伴脑室破入患者的预后影响。方法 选取2020年10月至2021年4月入我院接受治疗的152例HICH脑室破入患者,分别建立联合手术组和置管引流组,观察两组患者术中及术后各项指标、并发症发生情况、手术前后血清神经元特异性烯醇化酶(NSE)、神经营养因子(NGF)、P物质(SP)、血浆N末端脑钠肽前体(NT-proBNP)和血浆粒细胞巨噬细胞集落刺激因子(GM-CSF),对比术后6个月两组患者格拉斯哥预后(GOS)分级结果,单因素、二元Logistic回归分析联合组内患者预后不良的危险因素。结果 联合手术组血肿清除率、引流管留置时间、住院时间较置管引流组均明显降低(P<0.05),手术时间较置管引流组明显升高(P<0.05);联合手术组并发症总发生率较置管引流组明显降低(P<0.05);联合手术组术后NSE、SP、NT-proBNP、GM-CSF与置管引流组相比均明显降低,且联合手术组术后NGF与置管引流组相比均明显升高(P<0.05);手术后6个月联合手术组预后总不良率与置管引流组相比明显降低(P<0.05);二元Logistic回归分析显示年龄≥65岁、血肿清除率<85%、手术后7d NSE值≥7μg/L、手术后7d NGF值<90μg/L、手术后7d SP值<300ng/L是发生预后不良的独立危险因素。结论 神经内镜血肿清除术联合置管引流对HICH伴脑室破入患者可有效提升血肿清除率并降低术后感染等并发症发生率,亦可有效降低对患者神经功能的损害,可临床推广应用。

Objective To investigate the effect of neuroendoscopic hematoma removal combined with catheter drainage on the prognosis of patients with hypertensive cerebral hemorrhage(HICH)accompanied by ventricular rupture.Methods From October,2020 to April,2021,152 patients who were admitted to our hospital for treatment of HICH ventricular rupture were selected to establish a combined surgery group and a tube drainage group,respectively.We observed the intraoperative and postoperative indexes,complications,serum neuron-specific enolase(NSE),neurotrophic factor(NGF),substance P(SP),plasma N-terminal brain sodium peptide precursor(NT-proBNP)and plasma granulocyte macrophage colony-stimulating factor(GM-CSF).We also compared the Glasgow prognosis(GOS)grading results of patients in both groups at 6 months after surgery.Univariate and binary logistic regression analysis of risk factors for poor prognosis in patients in the combined group were conducted.Results The hematoma clearance rate,drainage tube retention time,and hospital stay were significantly lower in the combined surgery group compared with the tube drainage group(P<0.05),and the operative time was significantly higher in the combined surgery group compared with the tube drainage group(P<0.05);The overall complication rate was significantly lower in the combined surgery group compared with the tube drainage group(P<0.05);The postoperative NSE,SP,NT-proBNP,and GM-CSF were significantly lower in the combined surgery group compared with the tube drainage group,while the postoperative NGF was significantly higher in the combined surgery group compared with the tube drainage group(P<0.05).The postoperative NSE,SP,NT-proBNP,and GM-CSF were significantly lower in the combined surgery group compared with the drainage group,while the postoperative NGF was significantly higher in the combined surgery group compared with the drainage group(P<0.05);The overall poor prognosis was significantly lower in the combined surgery group compared with the drainage group 6 months after surgery(P<0.05);Binary logistic regression analysis showed that age≥65 years,hematoma clearance rate<85%,7d postoperative NSE value≥7μg/L,NGF value<90μg/L 7d after surgery,and SP value<300ng/L 7d after surgery were independent risk factors for the occurrence of poor prognosis.Conclusion Neuroendoscopic hematoma removal combined with tube drainage can effectively improve the rate of hematoma removal and reduce the incidence of postoperative infections and other complications in patients with HICH with ventricular rupture,and this approach can also effectively reduce the damage to neurological function.