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

摘要： 目的 评价神经内镜手术对脑室出血患者的治疗效果。方法 以2020年1月~2021年9月我院收治的脑室出血患者60例为研究对象,采用随机数字表法分为对照组(30例)和观察组(30例)。对照组采用脑室外引流术进行治疗,观察组在对照组的基础上联合神经内镜手术进行治疗,两组均观察至患者出院,并随访6个月。统计两组围术期指标及住院期间并发症发生情况、随访期间预后情况,比较两组术后1、3、7 d颅内压,术前及术后3、7 d血清炎性因子水平,术前及术后7、15、30 d神经功能。结果 观察组手术时间、脑脊液恢复正常时间、引流管置管时间、住院时间短于对照组,术后1 d血肿残余量低于对照组(P＜0.05),血肿清除率>90%患者占比(36.67%)高于对照组(6.67%,P＜0.05),血肿清除率<60%患者占比(10.00%)低于对照组(60.00%,P＜0.05)。术前及术后1、3、7 d,两组颅内压均呈逐渐降低趋势,不同时间点比较,差异具有统计学意义(P＜0.05);术后1、3、7 d,观察组颅内压低于对照组(P＜0.05)。术前及术后3、7 d,两组血清超敏-C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)水平均呈逐渐降低趋势,不同时间点比较,差异具有统计学意义(P＜0.05);术后3、7 d,观察组血清hs-CRP、IL-6、TNF-α、PCT水平低于对照组(P＜0.05)。术前及术后7、15、30 d,两组美国国立卫生研究院卒中量表(NIHSS)评分均呈逐渐降低趋势,不同时间点比较,差异具有统计学意义(P＜0.05);术后7、15、30,观察组NIHSS评分低于对照组(P＜0.05)。住院期间,观察组总并发症发生率(6.67%)与对照组(20.00%)比较,差异无统计学意义;随访6个月后,观察组预后良好率(60.00%)显著高于对照组(26.67%,P＜0.05)。结论 在脑室外引流术的基础上联合神经内镜手术治疗脑室出血患者,可有效缩短手术时间,提高血肿清除率,减少血肿残余量,同时缓解患者机体炎症反应,有助于改善患者神经功能,促进患者术后恢复,改善患者预后,具有较好的治疗效果。

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