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神经内镜微创手术治疗高血压脑出血的短期疗效及长期预后

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.

作者信息

Wei Jian-Hui, Tian Ya-Nan, Zhang Ya-Zhao, Wang Xue-Jing, Guo Hong, Mao Jian-Hui

机构信息

Department of Neurosurgery, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China.

Department of Neurology, Harrison International Peace Hospital, Hengshui 053000, Hebei Province, China.

出版信息

World J Clin Cases. 2021 Oct 6;9(28):8358-8365. doi: 10.12998/wjcc.v9.i28.8358.

Abstract

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 ( > 0.05).The SP level and Barthel index score of the two groups increased ( < 0.05) and the inflammatory factors and NIHSS score decreased ( < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group ( < 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.

摘要

背景

高血压性脑出血是常见的神经系统危急重症,占急性脑血管病的五分之一,致残率和死亡率高,严重影响患者生活质量。

目的

分析神经内镜微创手术治疗高血压性脑出血的短期疗效及长期预后。

方法

选取2018年3月至2020年5月收治的118例高血压性脑出血患者,根据手术方案分为对照组和观察组。对照组采用硬通道微创穿刺引流术,观察组采用神经内镜微创手术。记录血清P物质(SP)、炎症因子[肿瘤坏死因子-α、白细胞介素-6(IL-6)、IL-10]水平及美国国立卫生院卒中量表(NIHSS)评分、Barthel指数评分的变化情况,比较两组手术相关指标及预后。

结果

观察组手术时间(105.26±28.35)min,长于对照组,术中出血量比对照组多45.36±10.17 mL。48 h、72 h时血肿清除率分别比对照组高88.58%±4.69%、94.47%±4.02%。观察组预后良好率(86.44%)高于对照组,并发症发生率(5.08%)与对照组差异无统计学意义(>0.05)。两组SP水平及Barthel指数评分升高(<0.05),炎症因子及NIHSS评分降低(<0.05)。观察组细胞因子水平、NIHSS评分及Barthel指数评分优于对照组(<0.05)。

结论

神经内镜微创手术治疗高血压性脑出血较硬通道微创穿刺引流术复杂,但血肿清除更彻底,短期疗效及长期预后优于硬通道微创穿刺引流术。

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