关键词: 脑室出血, 神经内镜手术, 脑室外引流术, 血肿残余量, 炎性因子, 神经功能

Abstract: Objective To evaluate the effect of neuroendoscopic surgery on patients with intraventricular hemorrhage.Methods A total of 60 patients with intraventricular hemorrhage admitted to our hospital from January 2020 to September 2021 were selected as the research objects and divided into the control group (30 cases) and the observation group (30 cases) by random number table method.The control group was treated with external ventricular drainage,and the observation group was treated with neuroendoscopic surgery on the basis of the control group.The patients in both groups were observed until discharge,and were followed up for 6 months.The perioperative indicators,complications during hospitalization and prognosis during follow-up were statistically analyzed.Intracranial pressure before surgery and 1,3 and 7 d after surgery,level of serum inflammatory factor before surgery and 3 and 7 d after surgery,and neurological function before surgery and 7,15 and 30 d after surgery were compared between the two groups.Results The surgery time,cerebrospinal fluid recovery time,drainage tube placement time and hospital stay in the observation group were shorter than those in the control group,the residual volume of hematoma at 1 d after surgery was lower than that in the control group(P＜0.05),and the proportion of patients with hematoma clearance rate >90% (36.67%) was higher than that in the control group (6.67%).The proportion of patients with hematoma clearance rate <60% (10.00%) was lower than that of the control group (60.00%,P＜0.05).Before surgery and at 1,3,7 d after surgery,the intracranial pressure of the two groups gradually decreased,and the difference was statistically significant at different time points (P＜0.05).At 1,3,7 d after surgery,the intracranial pressure of the observation group was lower than that of the control group (P＜0.05).The serum levels of high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in the two groups were gradually decreased before surgery and 3 and 7 d after surgery,and the differences were statistically significant at different time points (P＜0.05).At 3 and 7 d after surgery,the serum levels of hs-CRP,IL-6,TNF-α and PCT in the observation group were lower than those in the control group (P＜0.05).The score of National Institutes of Health Stroke Scale (NIHSS) of the two groups showed a gradually decreasing trend before surgery and 7,15,and 30 d after surgery,and the differences at different time points were statistically significant (P＜0.05).The score of NIHSS of the observation group was lower than that of the control group at 7,15 and 30 d after surgery (P＜0.05).During hospitalization,there was no significant difference in the incidence of total complications between the observation group (6.67%) and the control group (20.00%).After 6 months of follow-up,the good prognosis rate of the observation group (60.00%) was significantly higher than that of the control group (26.67%,P＜0.05).Conclusion Outside the ventricle drainage on the basis of combined neural endoscopic surgery in patients with ventricular hemorrhage,which could effectively shorten the surgery time,improve the clearance of hematoma,reduce the residual amount of hematoma,at the same time the body inflammatory reaction,help improve neurologic patients,promote patients recovery and improve the prognosis of patients,had a good therapeutic effect.

Key words: Intraventricular hemorrhage, Neuroendoscopic surgery, External ventricular drainage, Residual volume of hematoma, Inflammatory factor, Neurological function