高血压脑出血患者微创颅内血肿清除术后对血管活性物质和TCD参数及血清sCD40L、MMP-9、HMGB-1水平的影响

Effects of minimally invasive intracranial hematoma removal surgery on vasoactive substances,TCD parameters,and serum sCD40L,MMP⁃9 and HMGB⁃1 levels in patients with hypertensive intracerebral hemorrhage

目的探讨微创颅内血肿清除术对高血压脑出血患者血管活性物质、TCD参数及血清可溶性CD40配体(sCD40L)、基质金属蛋白酶-9(MMP-9)、高迁移率族蛋白B1(HMGB-1)水平的影响。方法选取2022年1月-2023年6月于荣县人民医院收治的60例高血压脑出血患者为研究对象,根据治疗方式的不同将患者分为对照组(n=30)和研究组(n=30),对照组患者行小骨窗颅内血肿清除术治疗,研究组患者行微创颅内血肿清除术治疗。比较两组术前1 d,术后1、7、21 d血管活性物质[内皮素(ET)、血管升压素(AVP)]、TCD参数[收缩期峰血流速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)、搏动指数(RI)]及血清sCD40L、MMP-9、HMGB-1水平。结果术后1、7及21 d,研究组和对照组血清ET(F=77.469、25.806,P均<0.001)、AVP(F=252.399、68.781,P均<0.001)、s CD40L(F=121.190、70.891,P均<0.001)、MMP-9(F=140.814、265.522,P均<0.001)、HMGB-1(F=224.247、27.162,P均<0.001)水平较术前降低,且研究组以上指标水平低于对照组(P均<0.05),差异均有统计学意义。术后1、7及21 d,研究组和对照组Vs(F=5.314、5.535,P均<0.001)、Vd(F=15.620、15.357,P均<0.001)、Vm(F=8.053、8.640,P均<0.001)较术前明显升高,RI较术前明显降低(F=30.872、29.244,P均<0.001),差异均有统计学意义,但两组上述指标比较差异均无统计学意义(P均>0.05)。结论采用微创颅内血肿清除术治疗高血压脑出血患者具有较好的疗效,能够恢复患者血管舒缩功能,降低颅内压,减轻炎性反应,改善预后。

Objective To investigate the effects of minimally invasive intracranial hematoma removal surgery on vasoactive substances,TCD parameters,and serum levels of soluble CD40 ligand(sCD40L),matrix metalloproteinase⁃9(MMP⁃9),and high mobility group protein B1(HMGB⁃1)in patients with hypertensive intracerebral hemorrhage.Methods Sixty patients with hypertensive intracerebral hemorrhage were collected as the study subjects and separated into control group(n=30)and study group(n=30)according to different treatment methods.The control group received small bone window intracranial hematoma removal surgery,while the study group received minimally invasive intracranial hematoma removal surgery.The vasoactive substances[endothelin(ET),vasopressin(AVP)],TCD parameters[peak systolic blood flow velocity(Vs),end diastolic blood flow velocity(Vd),mean blood flow velocity(Vm),pulsatile index(RI)]and serum sCD40L,MMP⁃9,and HMGB⁃1 levels were compared between the two groups on the 1st day before surgery,1st day,7th day,and 21st day after surgery.Results After operation 1,7 and 21 days,the serum levels of ET(F=77.469,25.806;all P<0.001),AVP(F=252.399,68.781;all P<0.001),sCD40L(F=121.190,70.891;all P<0.001),MMP⁃9(F=140.814,265.522;all P<0.001),HMGB⁃1(F=224.247,27.162;all P<0.001)in the study group were lower than those in the control group,and the differences were statistically.Compared with preoperative surgery,1,7 and 21 d Vs(F=5.314,5.535;all P<0.001),Vd(F=15.620,15.357;all P<0.001),Vm(F=8.053,8.640;all P<0.001)increased significantly in study group and control group;RI(F=30.872,29.244;all P<0.001)significantly decreased in study group and control group,but the two groups were not statistically significant(P>0.05).Conclusion Minimally invasive intracranial hematoma removal surgery had a good therapeutic effect on patients with hypertensive intracerebral hemorrhage,which could restore the patient's vasomotor function,reduce intracranial pressure,alleviate inflammatory reactions,and improve prognosis.