Zhao Jianhua, Mao Qing, Qian Zhongxin, Zhu Jun, Qu Zhun, Wang Chao
Department of Neurosurgery, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China.
Department of Neurosurgery, Shanghai Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China.
Exp Ther Med. 2018 Jun;15(6):4906-4910. doi: 10.3892/etm.2018.6014. Epub 2018 Mar 30.
Mild hypothermia combined with minimally invasive hematoma evacuation was evaluated in the treatment of hypertensive intracerebral hemorrhage to reduce inflammatory response of brain tissue around hematoma and ameliorate brain function, and to investigate its safety, effectiveness and feasibility. A total of 206 patients with acute spontaneous hypertensive intracerebral hemorrhage were collected clinically and randomly divided into minimally invasive hematoma evacuation group (group A) and mild hypothermia combined with minimally invasive hematoma evacuation (group B). The National Institutes of Health Stroke Scale (NIHSS) score was used before and after treatment. Group A was treated with minimally invasive intracranial hematoma evacuation using intracranial hematoma grinding puncture needle while group B received whole body water circulation type cooling blanket plus local cerebral mild hypothermia therapy with ice cap on the basis of minimally invasive surgery. Patients brain tissue fragments around hematoma taken out with rinsing during operation and at postoperative 1, 3 and 7 days were investigated. The contents of tumor necrosis factor-α (TNF-α) in serum at postoperative 1, 3 and 7 days were evaluated by enzyme-linked immunosorbent assay (ELISA). For the degree of nerve function defect of patients in the two groups, NIHSS score was lower in group B than that in group A at days 3 and 7, and the differences were statistically significant (P<0.05). The serum TNF-α content and expression of nuclear factor-κB (NF-κB) in brain tissue around hematoma reached the peak on the 3rd day. The TNF-α content and NF-κB expression were lower in group B than those in group A at each time-point (P<0.05). Mild hypothermia combined with minimally invasive hematoma evacuation can reduce the damage of hematoma to the surrounding brain tissue, effectively alleviate inflammatory response and decrease brain tissue injury, thus ameliorating brain function.
评估亚低温联合微创血肿清除术治疗高血压性脑出血，以减轻血肿周围脑组织的炎症反应，改善脑功能，并探讨其安全性、有效性和可行性。临床收集206例急性自发性高血压性脑出血患者，随机分为微创血肿清除组（A组）和亚低温联合微创血肿清除组（B组）。治疗前后采用美国国立卫生研究院卒中量表（NIHSS）评分。A组采用颅内血肿粉碎穿刺针进行微创颅内血肿清除术，B组在微创手术基础上采用全身水循环式降温毯加冰帽局部脑亚低温治疗。术中及术后1、3、7天取患者血肿周围脑组织碎块冲洗后进行研究。采用酶联免疫吸附测定（ELISA）法评估术后1、3、7天血清中肿瘤坏死因子-α（TNF-α）的含量。两组患者神经功能缺损程度比较，B组在第3天和第7天的NIHSS评分低于A组，差异有统计学意义（P<0.05）。血肿周围脑组织血清TNF-α含量及核因子-κB（NF-κB）表达在第3天达到峰值。各时间点B组TNF-α含量及NF-κB表达均低于A组（P<0.05）。亚低温联合微创血肿清除术可减轻血肿对周围脑组织的损伤，有效减轻炎症反应，降低脑组织损伤，从而改善脑功能。
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