Effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage

Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases) and routine group (41 cases). Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and serum protein (SF), serum substance P (SP) in the 2 groups were detected before treatment and 2 weeks after treatment.Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05). TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01,P<0.05). TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01);The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01,P<0.05). SP in minimally invasive group increased more significantly than that in routine group (P<0.05).Conclusions:Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively.

Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery.Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group.Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage, and contribute to the neurological function recovery. TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage, but also has a certain value in evaluating the prognosis of neurological function.

Effect of urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle on the blood sugar and serum CRP in patients with hypertensive cerebral hemorrhage

Objective:To observe the clinical efficacy of urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle in the treatment of hypertensive cerebral hemorrhage and the effect on blood sugar and serum CRP.Methods:A total of 84 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group (n=53) and the conservative group (n=31) according to different treatment protocols. The patients in the two groups were given routine drug treatments. The patients in the observation group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. The blood sugar and serum CRP levels before and after treatment in the two groups were compared. CT was performed to reexamine the cerebral hematoma and edema volume.Results: The serum CRP and blood sugar levels 3, 7 and 14 d after treatment in the minimally invasive group were significantly lower than those in the conservative group (P<0.05). The cerebral hematoma and edema volume 1, 3, 7, and 14 d after treatment in the minimally invasive group was significantly lower than that in the conservative group (P<0.05).Conclusions: Urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle in the treatment of hypertensive cerebral hemorrhage can significantly alleviate the brain tissue injury, reduce the systemic inflammatory reaction and blood sugar level, and contribute to the rehabilitation.

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Surgical instruments hyalinization:Occlusion removal in minimally invasive endoscopic surgery

Minimal invasion is an important trend in surgery.However,the endoscope,as one of the key devices for monitoring the process of minimally invasive surgery,is limited by its size and working space it operates in,which result in a considerably narrow field of view.In particular,when a surgical instrument enters through the tool channel,the instrument occupies most of the area in an endoscopic image.This hampers the surgeon’s field of view and has a negative impact on the surgery.This study proposes a novel method for removing the occlusion caused by surgical instruments in endoscopic images by making foreground occlusions on endoscopic images transparent using image restoration and interframe information filling.Compared with unprocessed images,this method can provide a clearer field of view that is necessary for minimally invasive endoscopic surgeries and improve the quality of surgeries.Clinical endoscopic images are used to verify the feasibility of the proposed method,and the results show that the proposed method improves the visual effect of endoscopic images by removing surgical-instrument occlusions.This demonstrates the considerable potential of the proposed method for use in clinical applications.

注射体积对老年患者中等量基底节区脑出血微创穿刺术后临床疗效的影响

目的探讨药物总量控制下注射体积对老年患者中等量基底节区脑出血微创穿刺术后临床疗效的影响。方法以血肿最大层面长轴中心点为穿刺点,CT引导穿刺,穿刺成功后抽吸液态血肿,控制血肿腔内单次尿激酶总量4.0×10^(4)U,注射体积分别为2 mL和4 mL,根据术后CT结果调整针体深度,并根据血肿清除情况拔针。比较两组术后血肿清除率、颅内压、血肿周围水肿体积、总死亡率、并发症发生率、神经功能缺失评分(neurological deficit score,NDS)和日常生活能力评定(activities of daily living,ADL)结果。结果两组患者术后首次血肿清除率(31.17%±1.46%vs.30.50%±1.69%)、术后颅内压、总死亡率无明显差异(P均>0.05)。大体积组术后1 d(77.30%±3.75%vs.62.77%±3.89%),2 d(91.43%±4.05%vs.80.12%±4.15%),拔针前(92.35%±4.83%vs.85.9%±3.59%)血肿清除率明显高于小体积组(P<0.05)。大体积组留针时间(1.8 d±0.2 d vs.3.1 d±0.4 d,P<0.05)、尿激酶总用量(24.3×10^(4)U±2.3×10^(4)U vs.36.5×10^(4)U±4.7×10^(4)U,P<0.05)均少于小体积组(P<0.05)。大体积组术后3 d(11.33 mL±2.32 mL vs.16.45 mL±1.97 mL)、5 d(14.59 mL±2.11 mL vs.21.37 mL±2.43 mL)、7 d(22.79 mL±3.15 mL vs.30.15 mL±4.04 mL)、14 d(12.41 mL±1.95 mL vs.19.38 mL±2.47 mL)血肿周围水肿体积少于小体积组(P<0.05)。大体积组术后28 d、3个月、6个月NDS[分别为(22.35±2.49 vs.28.14±2.95)、(16.43±2.17 vs.23.81±2.56)、(11.39±1.87 vs.17.74±2.03)]及ADL评分[分别为(44.76±4.22 vs.36.15±2.36)、(62.55±3.81 vs.51.39±2.45)、(77.53±3.76 vs.60.81±4.35)]优于小体积组(P<0.05)。大体积组术后并发症发生率低于小体积组(P<0.05)。结论大体积注射法能更有效引流血肿,缩短留针时间,减少尿激酶用量,降低术后并发症发生率,改善患者预后,是老年中等量基底节区脑出血微创穿刺术后提高疗效的有效方法。

术前血清碱性磷酸酶、骨桥蛋白与基底节区脑出血患者神经内镜清除术预后的关系

目的分析术前血清碱性磷酸酶(ALP)与骨桥蛋白(OPN)与基底节区脑出血患者神经内镜清除术预后的关系,评估其对患者预后的预测价值。方法回顾性采集2019年1月至2023年6月于商丘市第一人民医院完成神经内镜下微创血肿清除术治疗的65例基底节区脑出血患者的资料。记录研究所需实验室指标结果数据,包括术前及术后血清ALP、OPN水平,统计术后1个月患者预后情况,分析脑出血患者术前血清ALP、OPN与预后的关系。结果65例基底节区脑出血患者预后不良14例,占比21.54%。术前及术后,预后不良组患者血清ALP、OPN高于预后良好组(P<0.05)。经过点二列相关性分析,术前血清ALP、OPN与脑出血患者预后不良呈正相关关系(r>0,P<0.05)。绘制受试者工作特征(ROC)曲线,结果显示,术前血清ALP、OPN预测脑出血患者预后不良的曲线下面积(AUC)均>0.70,联合预测的AUC>0.80,联合预测价值更高。结论基底节区脑出血患者神经内镜清除术前ALP、OPN越高,预后不良的可能性越大,术前ALP、OPN可以作为基底节区脑出血患者神经内镜清除术后预后不良的有效预测指标。

微创血肿清除术与开颅手术治疗脑出血的临床效果比较

目的对比分析脑出血患者采取微创血肿清除术与开颅手术治疗的效果,并探讨两种手术方式对患者康复情况的影响。方法采用回顾性研究的方式,将2020年4月—2023年4月本院收治的423例脑出血患者作为研究对象,按照手术方式将其分为A组(111例)和B组(312例)。其中,A组患者采取开颅血肿清除术,B组患者采取微创血肿清除术,患者的手术治疗时间均处于限期内。对比分析微创血肿清除术与开颅手术治疗的效果,评价指标为围手术期指标、康复情况、炎症因子。结果B组患者术中出血量少于A组,B组患者手术时间、住院时间均短于A组(P<0.05);手术后,两组患者NHISS评分均降低,GCS评分、ADL评分均升高,且B组患者变化程度大于A组(P<0.05);手术后,两组患者IL-6、hs-CRP、TNF-α水平均下降,且B组各指标水平均低于A组(P<0.05)。结论微创血肿清除术能够缩短患者手术后恢复时间,改善手术指标,并能增强患者神经功能,降低术后炎症反应,有效改善患者的昏迷状况,促进生活能力的提升,具有更高的安全性。

微创法腋臭去除术患者的手术配合以及护理分析

目的研究微创法腋臭去除术患者的手术护理配合以及护理方案。方法于我院微创法腋臭去除术治疗期间实施综合护理前后各随机抽取32例患者中,并作为对照组(实施前,行常规护理)和观察组(实施后,行综合护理),对比两组护理效果。结果观察组依从率(100.00%)较对照组(81.25%)明显提高(P<0.05)。观察组SAS(42.68±4.74)分,SDS(40.69±5.76)分,低于对照组[SAS(54.39±4.60)分,SDS(52.46±4.92)分](P<0.05)。观察组皮肤瘀斑1例(3.13%),皮下积液1例(3.13%),未见切口感染、血肿,合计2例(6.25%),少于对照组[皮肤瘀斑2例(6.25%),皮下积液3例(9.38%),切口感染2例(6.25%),血肿2例(6.25%),合计9例(28.13%)](P<0.05)。观察组满意度(96.88%)高于对照组(71.88%)(P<0.05)。观察组GCQ(76.22±6.39)分,显著优于对照组[GCQ(68.19±4.57)分](P<0.05)。结论对于微创法腋臭去除术患者的手术配合采取综合护理,可以缓解患者不良情绪,预防并发症,提高患者配合度和满意度,具有较高临床价值。

神经内镜微创手术治疗高血压脑出血的效果分析

目的:分析神经内镜微创手术治疗高血压脑出血的效果。方法:选取2020年1月—2022年12月新疆生产建设兵团第一师医院收治的高血压脑出血患者120例作为研究对象,依据双色球法分为观察组与对照组,各60例。对照组采取开颅血肿清除术治疗,观察组采取神经内镜微创手术治疗。比较两组临床疗效。结果:观察组手术时间短于对照组,术中出血量少于对照组,血肿清除率高于对照组,差异有统计学意义(P<0.001)。观察组术后并发症发生率低于对照组,差异有统计学意义(P=0.031)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.028)。观察组重症监护室观察时间及整体治疗时间短于对照组,差异有统计学意义(P<0.001)。结论:神经内镜微创手术治疗高血压脑出血的效果较好,其手术时间短、术中出血量少、血肿清除率高,术后并发症发生率低,患者恢复速度快。

清震汤加减联合微创血肿清除术治疗高血压脑出血临床研究

目的:观察清震汤加减联合微创血肿清除术治疗高血压脑出血的治疗效果。方法:抽取98例高血压脑出血患者为研究对象,按照随机数字表法分为试验组和对照组各49例。对照组行微创血肿清除术,术后给予西医常规治疗,试验组在对照组基础上联合清震汤加减治疗。比较2组颅内压(ICP)、美国国立卫生院卒中量表(NIHSS)评分与格拉斯哥昏迷指数(GCS),脑水肿体积和持续时间,血清肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)、基质金属蛋白酶-9(MMP-9)水平及中医证候评分。结果:术前,2组ICP值比较,差异无统计学意义(P>0.05);术后即刻及24 h、72 h、1周,试验组相同时间点的ICP值均低于对照组(P<0.05)。术前,2组NIHSS、GCS指数评分比较,差异无统计学意义(P>0.05);术后14 d,试验组NIHSS评分低于对照组(P<0.05),GCS指数高于对照组(P<0.05)。术后,试验组脑水肿体积、脑水肿持续时间低于对照组,差异有统计学意义(P<0.05)。术前,2组血清TNF-α、MMP-9、NGF水平比较,差异无统计学意义(P>0.05)。术后14 d,2组血清TNF-α、MMP-9水平较术前下降(P<0.05),血清NGF水平较术前上升(P<0.05);且试验组血清TNF-α、MMP-9水平低于对照组(P<0.05),NGF水平高于对照组(P<0.05)。术前,2组半身不遂、口眼歪斜、神志昏蒙等中医证候评分比较,差异无统计学意义(P>0.05);术后14 d,试验组上述各项中医证候评分均低于对照组(P<0.05)。结论:微创血肿清除术联合清震汤加减治疗高血压脑出血可降低ICP,减轻卒中症状和昏迷指数,减轻脑水肿,改善中医证候及炎症反应。

血肿微创清除联合脑血疏口服液治疗自发性脑出血的疗效及安全性的Meta分析与质量评价

目的:系统评价颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的疗效及安全性。方法:计算机检索从建库至2023年6月收录于中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)、维普中文科技期刊数据库(VIP Chinese science and technology journal database,VIP)、万方数据库、中国生物医学文献数据库(The Chinese biomedical literature database,CBM)、PubMed、Embase、the Cochrane Library等中英文数据库,结合纳入与排除标准筛选出所有颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血的临床随机对照试验,根据Cochrane系统评价手册对纳入研究进行偏倚风险评价,运用Revman5.4软件进行Meta分析,最后采用GRADE系统对结局指标进行证据质量评价。结果:共纳入9项研究,总样本量739例。其中,对照组371例,试验组368例。Meta分析结果显示,与血肿微创清除后仅予常规西医治疗相比,联合应用脑血疏口服液能够提高自发性脑出血患者临床治疗的总有效率[OR=5.47,95%CI=2.28,13.09,P=0.0001],在降低患者美国国立卫生研究所卒中量表评分[MD=−3.42,95%CI=−4.97,−1.87,P<0.0001]和中国脑卒中患者神经功能缺损程度评分[MD=−2.30,95%CI=−3.01,−1.58,P<0.00001],提高患者格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分[MD=1.51,95%CI=1.13,1.89,P<0.00001]和Barthel指数(Barthel index,BI)评分[MD=6.88,95%CI=4.49,9.27,P<0.00001],降低血清S100蛋白[MD=−0.02,95%CI=−0.03,−0.02,P<0.00001]和水通道蛋白4水平[MD=−0.02,95%CI=−0.03,−0.01,P=0.002]方面均具有明显优势。安全性方面,所纳研究均无严重不良反应;2项研究报告有恶心、腹胀、腹泻的胃肠道不适症状,其余研究未报告不良反应发生。结论:现有证据表明,颅内血肿微创清除手术联合脑血疏口服液治疗自发性脑出血疗效确切,能够明显减轻患者神经功能缺损和意识障碍程度,提高患者日常生活能力,改善患者生活质量,且具有一定的安全性。

自发性脑出血微创血肿清除术的研究进展

自发性脑出血(SICH)是一种高病死率和致残率的脑卒中疾病,微创血肿清除术可降低SICH患者的病死率并改善其功能预后。目前,有多种微创颅内血肿清除术可供选择,但各种技术的难易程度和疗效参差不齐。选择适宜或最佳的脑出血微创治疗方案对改善SICH患者的预后有重要意义。本文回顾了关于SICH微创血肿清除术的文献,分析主要几种手术的优缺点,为神经科医生选择最佳的脑出血微创治疗方案提供参考。目前尚无公认的最佳脑出血微创血肿清除术,但正在进行的多项大型微创血肿清除术临床试验有望为脑出血的最佳微创治疗策略提供重要信息。

立体定向仪联合颅内血肿清除术对高血压脑出血患者术后并发症及神经功能的影响

目的探究立体定向仪联合颅内血肿清除术对高血压脑出血患者术后并发症及神经功能的影响。方法选取2023年1月至2024年1月本院收治的80例高血压脑出血患者作为研究对象,采用随机数字表法分为对照组和试验组,各40例,对两组患者的均开展颅内血肿清除术,其中对照组采用简易定位颅内血肿清除术,试验组采用立体定向下颅内血肿清除术,对比两组患者的相关临床指标。结果试验组患者的神经功能、日常生活评分及手术指标均优于对照组(P<0.05);试验组炎性因子水平指标及并发症发生率均低于对照组(P<0.05)。结论通过立体定向仪结合颅内血肿清除术的方式能够有效改善患者的神经功能,让患者的术后并发症得到减少,有效保障患者的预后水平。

立体定向软通道微创血肿清除术治疗高血压脑出血的临床效果分析

目的分析立体定向软通道微创血肿清除术治疗高血压脑出血(HICH)的临床效果。方法将76例HICH患者根据手术方式不同分为参照组(38例,行传统手术治疗)和研究组(38例,行立体定向软通道微创血肿清除术治疗)。比较两组手术情况、神经功能、日常生活能力。结果研究组手术时间、住院时间短于参照组,血肿残余体积低于参照组,血肿清除率高于参照组(P<0.05)。术后1个月,研究组NIHSS评分低于参照组,BI评分高于参照组(P<0.05)。结论与传统手术相比,立体定向软通道微创血肿清除术治疗HICH的效果更好,可明显缩短患者的手术时间和住院时间,改善其神经功能及日常生活能力。

高血压脑出血患者血肿清除术后认知功能障碍的相关因素

目的探讨高血压脑出血(HICH)患者血肿清除术后认知功能障碍的相关因素。方法回顾性分析广州医科大学附属脑科医院2019-06—2023-06采用脑血肿清除术治疗的高血压脑出血患者的临床资料,以术后发生认知功能障碍(CD)的30例患者作为CD组,根据CD组患者的年龄、性别,按1∶2比例采用倾向匹配法从术后未发生CD的患者中筛选60例患者纳入无认知功能障碍(NCD)组。比较2组患者一般资料,将其中有统计学差异的因素代入Logistic分析,探索术后发生CD的相关因素(危险因素或保护因素)。各项相关因素采用概率法拟合构建风险模型,以受试者工作特征(ROC)曲线分析各危险因素与风险模型对HICH血肿清除术后CD发生的预测价值,计算诊断临界(cut-off)值。结果2组患者术中MAP均值、BIS均值与术后24hS100β、NSE、SOD水平比较,差异有统计学意义(P<0.05)。术中高MAP、BIS均值及术后24h高SOD水平为HICH血肿清除术后CD发生的保护因素(OR<1,P<0.05),术后24hS100β、NSE水平较高为CD发生的危险因素(OR≥1,P<0.05)。术中MAP均值≤89.815mmHg、术中BIS均值≤55.550、S100β≥1.957g·L^(-1)、NSE≥34.765g·L^(-1)、SOD≤67.865U·L^(-1)对于HICH血肿清除术后CD发生均具有中等预估价值(0.7<AUC≤0.9,P<0.05),据此构建的风险模型对于HICH血肿清除术后CD发生率具有较高预估价值(AUC>0.9,P<0.05)。结论术后24h高SOD水平为HICH血肿清除术后发生CD的保护因素,术后24hS100β、NSE水平较高为CD发生的危险因素,据此完善围术期检查及术中干预措施有利于降低高血压脑出血患者血肿清除术后认知功能障碍的发生概率。

依达拉奉与尼莫地平联合微创颅内血肿清除术治疗高血压脑出血的效果分析

目的探究高血压脑出血患者在微创颅内血肿清除术治疗期间联合依达拉奉、尼莫地平治疗的临床效果。方法100例高血压脑出血患者,按照随机的分组原则分为观察组和对照组,各50例。对照组实施微创颅内血肿清除术,观察组在对照组基础上联合依达拉奉注射液与尼莫地平注射液进行治疗。比较两组患者治疗前后的血清炎性因子、凝血功能指标、血肿体积以及预后情况。结果治疗后,两组患者超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均低于治疗前,且观察组患者hs-CRP(13.93±3.25)mg/L、IL-6(34.96±1.48)pg/ml、TNF-α(9.63±0.86)pg/ml均低于对照组的(19.78±4.17)mg/L、(47.64±1.59)pg/ml、(13.52±3.19)pg/ml,具有显著差异(P<0.05)。治疗后,两组患者D二聚体(D-D)均低于治疗前,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均短于治疗前,且观察组的D-D(0.82±0.21)mg/L明显低于对照组的(1.39±0.39)mg/L,PT(12.93±0.98)s、APPT(29.63±6.16)s均短于对照组的(14.25±0.96)、(32.52±5.24)s,具有显著差异(P<0.05)。治疗后,观察组血肿体积(3.64±0.31)ml小于对照组的(3.86±0.20)ml,具有显著差异(P<0.05)。观察组预后优良率90.0%高于对照组的52.0%,具有显著差异(P<0.05)。结论高血压脑出血患者实施微创颅内血肿清除术治疗期间联合应用依达拉奉、尼莫地平,可改善患者病症,缩小血肿体积,值得临床借鉴。

早期颅内血肿微创清除术治疗轻中度基底核区高血压脑出血的临床效果分析

目的分析早期颅内血肿微创清除术应用在轻中度基底核区高血压脑出血(HICH)中的临床效果。方法80例轻中度的基底核区HICH患者,依据随机数字表法划分为研究组和对照组,每组40例。对照组采取保守方式治疗,研究组实施早期颅内血肿微创清除术治疗。对比两组治疗效果、神经功能评分、认知功能评分及并发症发生情况。结果研究组总有效率为95.00%,与对照组77.50%相比更优,差异具有统计学意义(P<0.05)。治疗前,两组神经功能评分对比,差异无统计学意义(P>0.05);治疗后,研究组神经功能评分(13.64±2.12)分比对照组的(19.74±5.26)分低,差异具有统计学意义(P<0.05)。研究组注意评分(5.71±0.43)分、命名评分(2.76±0.24)分、语言流畅评分(1.99±0.37)分、定向力评分(5.97±0.45)分、延迟记忆评分(2.96±0.33)分、抽象思维评分(1.65±0.33)分、视空间的执行能力评分(4.79±0.53)分、总分(23.85±5.47)分与对照组的(4.12±0.49)、(2.04±0.03)、(1.52±0.08)、(4.06±0.32)、(1.76±0.14)、(1.14±0.21)、(4.02±0.46)、(17.28±2.35)分相比更高,差异具有统计学意义(P<0.05)。研究组并发症发生率7.50%与对照组25.00%相比较低,差异具有统计学意义(P<0.05)。结论早期颅内血肿微创清除术应用在轻中度的基底核区HICH患者效果较好,可帮助患者更好地恢复其神经功能,帮助患者提升认知功能,降低术后并发症,能有效促进其早日康复,临床上值得推广使用。

高血压脑出血患者微创血肿清除术后发生脑梗死的危险因素及预测模型构建

目的探讨高血压脑出血(HCH)患者微创血肿清除术后脑梗死发生风险及其危险因素,构建其风险预测模型。方法回顾收集2019年1月至2022年8月信阳市中心医院136例已接受微创血肿清除术治疗的HCH患者的资料,根据患者术后脑梗死发生情况分为梗死组和未梗死组。收集并对比两组资料,采用单因素和多因素分析HCH患者微创血肿清除术后脑梗死发生的危险因素,构建列线图模型并绘制受试者工作特征(ROC)曲线验证其预测效能。结果136例接受微创血肿清除术的高血压性脑出血患者中38例(27.94%)术后发生脑梗死;经单因素、多因素logistic回归分析提示,脑出血量、收缩压、脑组织移位、高血压病程、舒张压均为接受微创血肿清除术治疗高血压性脑出血患者术后脑梗死发生的危险因素(P<0.05);绘制列线图构建预测术后脑梗死的风险模型,验证模型区分度显示C-index值为0.887,提示区分度良好;绘制标准曲线提示模型准确度良好。绘制ROC曲线提示该模型评估接受微创血肿清除治疗的高血压性脑出血患者术后脑梗死发生曲线下面积为0.887,提示预测效能较好。结论脑出血量、收缩压、脑组织移位、高血压病程、舒张压均为接受微创血肿清除术治疗高血压性脑出血患者术后脑梗死发生的危险因素,基于上述危险因素构建的风险预测模型有较高的预测价值。