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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2018, Vol. 04 ›› Issue (06) : 344 -348. doi: 10.3877/cma.j.issn.2095-9141.2018.06.007

所属专题： 文献；

临床研究

神经内镜微创术联合置管吸引术治疗脑出血的疗效分析
张杰1,†(), 王恩任1, 张列1, 刘海波1   
  1. 1. 610500　成都，成都医学院第一附属医院神经外科
  • 收稿日期:2018-11-13 出版日期:2018-12-15
  • 通信作者: 张杰
  • 基金资助:
    四川省卫生厅科研项目(100103)

Efficacy of endoscopic minimally invasive surgery combined with tube aspiration for intracerebral hemorrhage

Jie Zhang1,†(), Enren Wang1, Lie Zhang1, Haibo Liu1   

  1. 1. Department of Neurosurgery, the First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
  • Received:2018-11-13 Published:2018-12-15
  • Corresponding author: Jie Zhang
  • About author:
    Corresponding author: Zhang Jie, Email:
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张杰, 王恩任, 张列, 刘海波. 神经内镜微创术联合置管吸引术治疗脑出血的疗效分析[J]. 中华神经创伤外科电子杂志, 2018, 04(06): 344-348.

Jie Zhang, Enren Wang, Lie Zhang, Haibo Liu. Efficacy of endoscopic minimally invasive surgery combined with tube aspiration for intracerebral hemorrhage[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(06): 344-348.

目的

分析神经内镜微创术联合置管吸引术治疗脑出血的临床疗效。

方法

选取成都医学院第一附属医院神经外科自2015年1月至2018年1月收治的100例脑出血患者，按照随机信封法分为观察组与对照组。对照组患者采用神经内镜微创技术治疗，观察组患者采用神经内镜微创术联合置管吸引术治疗，采用NIHSS评分对患者治疗前及治疗后30 d的神经功能进行评估，记录治疗前及治疗后3个月超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）及白细胞介素6（IL-6）水平。对比2组患者术后并发症发生情况及术后24 h血肿清除率情况，随访半年记录治疗总有效率。

结果

观察组治疗总有效率高于对照组，差异具有统计学意义（P<0.05）；观察组患者24 h血肿清除率高于对照组，且再次出血及电解质紊乱发生率低于对照组，差异均具有统计学意义（P<0.05）。但2组患者颅内感染发生率比较，差异无统计学意义（P>0.05）。治疗后观察组NIHSS评分低于对照组，差异具有统计学意义（P<0.05）。治疗后观察组TNF-α、hs-CRP及IL-6水平低于对照组，差异具有统计学意义（P<0.05）。

结论

采用神经内镜微创术联合置管吸引术对脑出血治疗后可有效提高临床疗效，降低不良反应发生率并改善患者预后质量。

关键词: 脑出血, 神经内镜微创术, 置管吸引术
Objective

To analyze the clinical efficacy of neuroendoscopic microtrauma combined with catheter aspiration in the treatment of cerebral hemorrhage.

Methods

A total of 100 patients with cerebral hemorrhage, admitted to the Department of Neurosurgery, the First Affiliated Hospital of Chengdu Medical College from January 2015 to January 2018, were selected and divided into the observation group and the control group according to the random envelope method. The control group was treated with neuroendoscopic minimally invasive technology, while the observation group was treated with neuroendoscopic minimally invasive surgery combined with catheter aspiration. The neurological function of the patients before and 30 d after treatment was evaluated by NIHSS. The levels of hypersensitive c-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) were recorded before and 3 months after treatment. Comparing the incidence of complications and the clearance rate of hematoma 24 h after operation between the 2 groups, the total effective rate of treatment was recorded after half a year follow-up.

Results

The total effective rate of the observation group was higher than that of the control group, with statistical significance (P<0.05); the clearance rate of hematoma in the observation group was higher than that in the control group at 24 h, and the incidence of re-bleeding and electrolyte disturbance was lower than that in the control group, with statistical significance (P<0.05). However, there was no significant difference in the incidence of intracranial infection between the two groups (P>0.05). After treatment, the NIHSS score of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). After treatment, the levels of TNF-α, hs-CRP and IL-6 in the observation group were lower than those in the control group, with statistical significance (P<0.05).

Conclusion

Neuroendoscopic microtrauma combined with catheter aspiration can effectively improve the clinical efficacy, reduce the incidence of adverse reactions and improve the prognosis of patients with intracerebral hemorrhage.

Key words: Cerebral hemorrhage, Neuroendoscopic microtrauma, Catheter aspiration
表1 2组患者治疗半年总有效率比较
组别 例数 治愈 有效 无效 有效率（%）
观察组 50 31 14 5 45（90.00）
对照组 50 23 13 14 36（72.00）
χ2值 ? ? ? ? 5.263
P值 ? ? ? ? 0.022
表2 2组患者术后并发症发生率及术后24 h血肿清除率比较[例（%）]
组别 24 h血肿清除率 术后并发症
再次出血 电解质紊乱 颅内感染
观察组 43（86.00） 3（6.00） 4（8.00） 2（4.00）
对照组 34（68.00） 8（16.00） 10（20.00） 3（6.00）
χ2值 8.346 5.107 5.980 0.421
P值 0.001 0.024 0.015 0.516
表3 2组患者治疗前后NIHSS评分比较（±s，分）
组别 治疗前 治疗后 t值 P值
观察组 45.83±7.29 8.29±1.10 36.005 0.001
对照组 44.05±8.17 13.29±2.07 25.807 0.001
t值 1.120 15.083 ? ?
P值 0.266 0.001 ? ?
表4 2组患者治疗前后血清炎性因子水平比较（±s，ng/L）
指标 观察组 对照组
治疗前 治疗后 治疗前 治疗后
TNF?α 105.92±10.21 22.48±6.15 105.67±13.28 39.19±8.91
hs?CRP 87.19±10.17 37.35±6.92 88.11±9.91 47.83±10.04
IL?6 45.54±7.19 19.67±5.83 46.19±8.27 32.18±6.32
t值 7.469 6.695 5.394 4.968
P值 0.021 0.015 0.027 0.019
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