血肿抽吸联合低后位去骨瓣治疗高血压性脑出血的疗效分析

Analysis of the efficacy of hematoma aspiration combined with low posterior osteotomy in the treatment of hypertensive intracerebral hemorrhage

目的 探讨高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)患者应用血肿抽吸联合低后位去骨瓣术与小骨窗开颅血肿清除术治疗对神经功能及预后的影响。方法 选取2020年2月至2022年2月甘肃省人民医院神经外科132例HICH患者,根据手术方式分为小骨窗组(n=52)、抽吸组(n=80),采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清中神经元特异性烯醇化酶(neuron specific enolase,NSE)、白细胞介素(interleukin,IL)-6水平,比较术中情况(手术时长及术中失血量)、颅内压、颅内血肿完全清除率、术后并发症发生率,应用日常生活能力量表(activity of daily living scale,ADL)对患者预后状况进行评估。结果 两组患者术前血清NSE、IL-6水平比较,差异无统计学意义(P>0.05);术后患者血清中的NSE与IL-6水平较术前均明显降低,颅内压在治疗后均较治疗前好转,差异有统计学意义(P<0.05)。抽吸组患者术后血清中的NSE、IL-6水平及手术时长、术后颅内压、并发症总发生率均低于小骨窗组患者(P<0.05);术中失血量及远期并发症总发生率与小骨窗组患者相比差异无统计学意义(P>0.05);术后6个月随访中,抽吸组患者预后良好率高于小骨窗组,差异有统计学意义(P<0.05);两组患者的颅内血肿完全清除率比较,差异无统计学意义(P>0.05)。结论 血肿抽吸联合低后位去骨瓣术可有效治疗HICH,促进患者的神经功能恢复。

Objective To explore the effect of hematoma aspiration device combined with low posterior osteotomy and small bone window craniotomy on neurological function and prognosis in patients with hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 132 patients with HICH in the Department of Neurosurgery,Gansu Provincial people’s Hospital from February 2020 to February 2022 were collected and divided into small bone window group(n=52)and aspiration group(n=80).The levels of serum neuron specific enolase(NSE)and interleukin-6(IL-6)were detected by enzyme linked immunosorbent assay(ELISA).The intraoperative condition(duration of operation and intraoperative blood loss),intracranial pressure,complete clearance rate of intracranial hematoma and the incidence of postoperative complications were compared.The prognosis of the patients was evaluated by activity of daily living scale(ADL).Results There was no significant difference in the levels of serum NSE and IL-6 between the two groups before operation(P>0.05).The levels of NSE and IL-6 in serum after operation were significantly lower than those before operation,and the intracranial pressure was improved after treatment,the difference has statistic significance(P<0.05).The postoperative serum NSE and IL-6 levels,operation duration,postoperative intracranial pressure and the total incidence of complications in aspiration group were lower than those in small bone window group(P<0.05),but there was no significant difference in intraoperative blood loss and the total incidence of long-term complications between the two groups(P>0.05).During the 6-month follow-up after surgery,the good prognosis rate of aspiration group was higher than that of small bone window group,and the difference was statistically significant(P<0.05);There was no statistically significant difference in the complete clearance rate of intracranial hematoma between the two groups of patients(P>0.05).Conclusion Low posterior osteotomy combined with hematoma aspiration can effectively treat HICH,promote the recovery of neurological function in patients.