神经内镜辅助下经颞下入路治疗重症脑干出血的临床研究

doi:10.19854/j.cnki.1008-2425.2024.01.0008

摘要/Abstract

摘要： 目的分析神经内镜辅助下经颞下入路治疗重症脑干出血的临床疗效。方法回顾性分析我院2021年1月至2023年1月收治的重症脑干出血患者78例,根据家属意愿分为手术组和保守治疗组。手术组36例,保守组42例。手术组应用神经内镜经颞下入路清除血肿,保守组按脑出血的治疗指南对症治疗。对比两组并发症、临床预后及血清中神经元特异性烯醇化酶(NSE)和S100钙结合蛋白(S100B)含量变化。结果两组并发症相比手术组重症肺炎、下肢静脉血栓、电解质紊乱、应激性溃疡发生的人数均少于保守组,两组对比P＜0.05,差异有统计学意义。通过两组格拉斯哥预后评分(glasgow prognostic score,GOS)对比发现手术组中能正常生活、轻度残疾人数多于保守治疗组,重度残疾人数少于保守治疗,两组对比P＜0.05,差异有统计学意义。经治疗1周、2周后对比发现手术组血清中NSE、S100B含量较保守组明显降低,两组对比P＜0.05,差异有统计学意义。结论神经内镜辅助下经颞下入路治疗重症脑干出血能降低患者的并发症及死亡率,提高患者的预后。

关键词: 神经内镜, 颞下入路, 临床预后, 并发症

Abstract: Objective Analyze the clinical efficacy of endoscopic assisted subtemporal approach in the treatment of severe brainstem hemorrhage. Methods Retrospective analysis of 78 patients with severe brainstem hemorrhage admitted to our hospital from January 2021 to January 2023,according to the choice of the patients' family members,they were divided into operation group and conservative management.There were 36 cases in the surgical group and 42 cases in the conservative group.The surgical group used endoscope to clear the hematoma through the subtemporal approach,while the conservative group used symptomatic treatment according to the treatment guidelines for cerebral hemorrhage.Compare the complications,clinical prognosis,and changes in serum NSE and S100B levels between the two groups. Results Compared with the conservative group,the number of patients with severe pneumonia,lower limb venous thrombosis,electrolyte disorder and Irritability ulcer in the operation group was less than that in the conservative group.The difference between the two groups was statistically significant (P＜0.05).By comparing the Glasgow prognostic score (GOS) of the two groups,it was found that the number of patients with normal life and mild disability in the operation group was more than that in the Conservative management group,and the number of patients with severe disability was less than that in the Conservative management group.The difference between the two groups was statistically significant (P＜0.05).After 1 and 2 weeks of treatment,it was found that the levels of NSE and S100B in the serum of the surgical group were significantly lower than those of the conservative group,with a statistically significant difference (P＜0.05). Conclusion The treatment of severe brainstem hemorrhage through the infratemporal approach assisted by neuroendoscopy can reduce complications and mortality in patients,and improve their prognosis.

Key words: Neuroendoscope, Subtemporal approach, Clinical prognosis, Complication

中图分类号:

R743.34

杨利辉, 贾亚男, 宋纪宁, 马克杰, 苏建龙, 宋志俊. 神经内镜辅助下经颞下入路治疗重症脑干出血的临床研究[J]. 立体定向和功能性神经外科杂志, 2024, 37(1): 39-43.

Yang Lihui, Jia Yanan, Song Jining, Ma Kejie, Su Jianlong, Song Zhijun. Clinical study on the treatment of severe brainstem hemorrhage through subtemporal approach assisted by neuroendoscopy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(1): 39-43.

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