不同入路神经内镜下血肿清除术治疗高血压脑出血的效果分析

Analysis of the therapeutic effi cacy of hematoma evacuation under neuroendoscopy through diff erent surgical approaches in the treatment of hypertensive intracerebral hemorrhage

目的探讨不同入路神经内镜下血肿清除术治疗高血压脑出血的效果。方法选取82例高血压脑出血患者,根据手术方法的不同分为经额入路组和经颞入路组,各41例。经额入路组和经颞入路组分别经额叶、颞叶入路行神经内镜下血肿清除术,2组术后均随访3个月。比较2组术后3个月的疗效;术前,术后1周、3周的神经功能及意识状态,术前、术后24 h的炎症介质,术前、术后3 d的神经营养因子和随访期间的并发症发生情况。结果较经颞入路组,经额入路组术后引流时间更短,血肿清除率更高(P<0.05);较术前,2组术后1周、3周的美国国立卫生研究院卒中量表(NIHSS)评分逐渐降低,格拉斯哥昏迷评分法(GCS)评分逐渐升高(P<0.05);与术后1周比较,经额入路组术后3周的NIHSS评分、GCS评分均优于经颞入路组(P<0.05);较术前,2组术后24 h的血清C反应蛋白(CRP)、肿瘤坏死因子α(TNF)、降钙素原(PCT)、白细胞介素-6(IL-6)水平升高(P<0.05);较术前,2组术后3 d的血清血清脑源性神经营养因子(BDNF)、胶质纤维酸性蛋白(GFAP)、神经生长因子(NGF)水平升高,且经额入路组高于经颞入路组(P<0.05);血清烯醇化酶(NSE)水平降低,且经额入路组低于经颞入路组(P<0.05)。结论经额和经颞叶入路神经内镜下血肿清除术治疗高血压脑出血均可发挥良好的疗效和安全性,且二者均对炎症介质的影响较小,但相比经颞叶入路,经额叶入路可缩短患者术后引流时间,提高血肿清除率,并可调节患者机体神经营养因子水平,改善患者神经功能及意识状态。

Objective To explore the therapeutic effi cacy of hematoma evacuation under neuroendoscopy through diff erent surgical approaches in the treatment of hypertensive intracerebral hemorrhage.Methods 82 patients with hypertensive intracerebral hemorrhage were selected and divided into the trans-frontal approach group and the trans temporal approach group according to diff erent surgical methods,with 41 patients in each group.The trans-frontal approach group and tran-temporal approach group underwent hematoma evacuation under neuroendoscopy through frontal and temporal lobe approaches,respectively.Both groups were followed up for 3 months after surgery.The therapeutic effi cacy of two groups at 3 months after surgery was compared.The neurological function and conscious state of two groups before surgery,at 1 week and 3 weeks after surgery were compared.The levels of infl ammatory mediators of two groups before surgery,and at 24 hours after surgery were compared.The levels of neurotrophic factors of two groups befoe surgery and at 3 days after surgery,and the occurrence of complications of two groups during the followed-up were compared.Results Compared with trans-temporal approach group,the postoperative drainage time was shorter and the hematoma evacuation rate was higher in the trans-frontal approach group(P<0.05).Compared with before surgery,in both groups the National Institute of Health Stroke Scale(NIHSS)score gradually decreased,and the Glasgow Coma Scale(GCS)score gradually increased at 1 week and 3 weeks after surgery(P<0.05).Compared with 1 week after surgery,the NIHSS score and GCS score of the trans-frontal approach group were better than those of the trans-temporal approach group at 3 weeks after surgery(P<0.05).Compared with before surgery,serum levels of C-reactive protein(CRP),tumor necrosis factor(TNF),PCT,and interleukin-6(IL-6)increased in two groups at 24 hours after surgery(P<0.05).Compared with before surgery,serum levels of BDNF,GFAP and NGF in two groups increased at 3 days after surgery,and the trans-frontal approach group was higher than the trans-temporal approach group(P<0.05);And serum level of NSE decreased,and the trans-frontal approach group was lower than the trans-temporal approach group(P<0.05).Conclusion Hematoma evacuation under neuroendoscopy through frontal and temporal lobe approaches has good effi cacy and safety in the treatment of hypertensive intracerebral hemorrhage,and both methods have relatively small impact on infl ammatory mediators.However,compared with the trans-temporal lobe approach,the trans-frontal lobe approach can shorten the postoperative drainage time of the patients,increase the rate of hematoma evacuation,and regulate the levels of neurotrophic factors in the patient's body,and improve the neurological function and conscious state of the patients.