不同时机行颅内血肿微创清除术治疗高血压脑出血患者的临床效果

doi:10.19854/j.cnki.1008-2425.2024.06.0008

摘要/Abstract

摘要： 目的探讨不同时机行颅内血肿微创清除术治疗高血压脑出血(HICH)患者的临床效果。方法选取2018 年7 月-2019 年12 月我院HICH患者150例,均行颅内血肿微创清除术,根据患者不同手术时机分为3组,超早期组发病6 h内实施手术,早期组于发病7～72 h内实施手术,延迟期组于发病72 h后实施手术。比较3组血肿清除率、再出血率、手术前神经损伤因子[神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、神经肽Y(NPY)]、神经缺损程度(NIHSS评分)、预后状态(GOS评分)日常活动能力(ADL评分)及并发症。结果超早期组、早期组血肿清除率高于延迟期组(P＜0.05),超早期组再出血率高于早期组、延迟期组(P＜0.05);超早期组、早期组术后血清NSE、S100B、NPY水平均低于延迟期组(P＜0.05);术后,超早期组、早期组NIHSS评分低于延迟期组,GOS、ADL评分高于延迟期组(P＜0.05);早期组并发症发生率低于超早期组、延迟期组(P＜0.05)。结论 HICH发病7～72 h内行YL-1型颅内血肿微创清除术可取得与6 h内行手术治疗相当的血肿清除率与远期效果,且能降低再出血与并发症风险,促进术后神经功能恢复。

关键词: 高血压脑出血, YL-1型, 血肿微创清除术, 手术时机, 血肿清除率, 再出血率, 神经功能, 并发症

Abstract: Objective To investigate the clinical effect of minimally invasive removal of intracranial hematoma at different times for the treatment of hypertensive intracerebral hemorrhage (HICH) patients. Methods A total of 150 patients with HICH in our hospital from July 2018 to December 2019 were selected and underwent minimally invasive removal of intracranial hematoma.They were divided into three groups based on different surgical timing:the ultra-early group underwent surgery within 6 hours of onset,the early group underwent surgery within 7-72 hours of onset,and the delayed group underwent surgery after 72 hours of onset.The hematoma clearance rate,rebleeding rate,preoperative neurologic injury factors [neuron-specific enolase (NSE),S100B protein (S100B),neuropeptide Y (NPY)],degree of neurological deficit (NIHSS score),prognosis status (GOS score),daily activity ability (ADL score),and complications were compared among the three groups. Results The hematoma clearance rate in the ultra-early group and early group was higher than that in the delayed group (P＜0.05),and the rebleeding rate in the ultra-early group was higher than that in the early group and delayed group (P＜0.05).The levels of serum NSE,S100B,and NPY in the ultra-early group and early group were lower than those in the delayed group after surgery (P＜0.05).The NIHSS scores in the ultra-early group and early group were lower than those in the delayed group after surgery,while the GOS and ADL scores were higher than those in the delayed group (P＜0.05).The incidence of complications in the early group was lower than that in the ultra-early group and delayed group (P＜0.05). Conclusion Within 7~72 hours of the onset of HICH,performing YL-1 minimally invasive intracranial hematoma removal surgery can achieve a hematoma clearance rate and long-term effect comparable to that of surgery performed within 6 hours,and can reduce the risk of rebleeding and complications,promoting postoperative neurological recovery.

Key words: Hypertensive cerebral hemorrhage, YL-1 type, Minimally invasive removal of hematoma, Operation timing, Hematoma clearance rate, Rebleeding rate, Nerve function, Complication

农胜德, 陆万流, 甘伟雄, 黄朝觉, 陆明雄. 不同时机行颅内血肿微创清除术治疗高血压脑出血患者的临床效果[J]. 立体定向和功能性神经外科杂志, 2024, 37(6): 363-367.

Nong Shengde, LuWanliu, Lu Mingxiong, Huang Chaojue, Gan Weixiong. Clinical effect of minimally invasive removal of intracranial hematoma at different times for the treatment of hypertensive intracerebral hemorrhage patients[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(6): 363-367.

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