通过对比高血压脑出血开颅血肿清除术与微创钻孔引流术后患者血清肿瘤坏死因子α（TNF-α）、S100β蛋白、神经元特异性烯醇化酶（NSE）水平及GCS评分的变化，比较2种方法对脑损伤的影响。

选取山西医科大学第一医院神经外科自2016年7月至2017年7月收治的高血压脑出血患者46例，分为钻孔组（22例）和开颅组（24例）；对照组为同期健康体检者20例。钻孔组和开颅组术后1、3、7、14 d检测血清TNF-α、S100β、NSE并进行GCS评分，对照组检测血清TNF-α、S100β、NSE。比较钻孔组和开颅组术后1、3、7、14 d及对照组的血清TNF-α、S100β、NSE及GCS评分。

钻孔组与开颅组术后初期的血清TNF-α、S100β、NSE均高于正常水平，先达到高峰，之后逐渐下降（TNF-α：F=38.629，P=0.000；S100β：F=33.381，P=0.000；NSE：F=25.619，P=0.000）；2组GCS评分于术后1~7 d均较低，术后14 d有所增加，但仍低于正常水平（F=11.569，P=0.000）。术后1、3、7、14 d，钻孔组与开颅组血清TNF-α、S100β、NSE和GCS评分差异无统计学意义（P>0.05）。

开颅血肿清除术与钻孔引流术对高血压脑出血患者血清TNF-α、S100β、NSE及GCS评分的影响无差异，即两种方案对脑损伤的影响无差异，不能断定开颅血肿清除术较钻孔引流术效果差，两种术式各有优缺点，临床上需根据不同情况灵活应用。

To compare the levels of serum tumor necrosis factor alpha (TNF-α), S100β, neuron specific enolase (NSE) and GCS score in patients with hypertensive intracerebral hemorrhage after craniotomy and drainage and to compare the effects of two methods on brain injury.

Forty-six cases of hypertensive cerebral hemorrhage in The First Hospital of Shanxi Medical University were divided into drilling group (22 cases) and craniotomy group (24 cases), and the control group were 20 healthy persons for physical examination in the same period. The serum levels of TNF-α, S100β, NSE and GCS score were measured at 1^st, 3^rd, 7^th and 14^th days after operation in the drilling and craniotomy groups, and the serum levels of TNF-α, S100β, NSE in the control group were measured. The serum levels of TNF-α, S100β, NSE and GCS score were compared between the drilling group and the craniotomy group at 1^st, 3^rd, 7^th and 14^th days after operation and the control group.

The serum TNF-α, S100β, NSE in the drilling group and the craniotomy group were higher than the normal level at the early postoperative period, and they both peaked at the beginning and then gradually decreased (TNF-α: F=38.629, P=0.000; S100β: F=33.381, P=0.000; NSE: F=25.619, P=0.000). The GCS scores of the 2 groups were lower on the 1^st to 7^th days after operation, and they both increased on the 14^th day after operation and were still lower than normal levels (F=11.569, P=0.000). At 1^st, 3^rd, 7^th and 14^th days after operation serum TNF-α, S100β, NSE and GCS scores in the drilling group and the craniotomy group were not statistically different (P>0.962).

There was no difference in the effect of craniotomy and drainage on the serum levels of TNF-α, S100β, NSE and GCS scores in patients with hypertensive intracerebral hemorrhage. There is no difference in the effect of the two programs on brain injury. Craniotomy hematoma removal can not easily be considered less effective than drilling and drainage, and two kinds of surgery have their own advantages and disadvantages. Clinical applications need to be flexible according to different situations.