作者：唐俊，许文豪，李渊

单位：

214200江苏省宜兴市中医医院神经外科

Units：

Department of Neurosurgery, Yixing Hospital of Traditional Chinese Medicine, Yixing 214200, China

关键词：

颅内出血，高血压性；微创血肿清除术；开颅手术；疗效比较研究

Keywords：

　Intracranial hemorrhage, hypertensive; Minimally invasive hematoma evacuation; Craniotomy; Comparative effectiveness research

CLC：

R 743.34

DOI：

10.12114/j.issn.1008-5971.2023.00.186

Funds：

江苏省自然科学基金资助项目（BK20211011）

摘要：

目的　比较CT定位配合微创血肿清除术与传统开颅手术治疗高血压脑出血患者的效果。方法　选取 2017年3月— 2022年3月宜兴市中医医院收治的高血压脑出血患者 103例为研究对象，采用信封法将患者随机分为开 颅组（ n= 51）及微创组（ n=52）。开颅组患者进行传统开颅手术治疗，微创组患者进行 CT定位配合微创血肿清除术 治疗。比较两组手术情况（血肿清除率、术后自动睁眼时间、术中出血量）及入住ICU时间，术前、术后1周、术后 2周、术后4周采用美国国立卫生研究院卒中量表（NIHSS）评估患者神经功能，比较两组术前及术后3 d血清神经元 特异性烯醇化酶（NSE）、神经肽Y（NPY）、脑源性神经营养因子（BDNF）水平，入院时及出院时采用简易精神 状态检查量表（MMSE）评估患者认知功能，记录患者术后并发症发生情况。结果　微创组血肿清除率低于开颅组， 术后自动睁眼时间及入住ICU时间短于开颅组，术中出血量少于开颅组（P＜0.05）。治疗方法与时间在NIHSS评分 上存在交互作用（P＜0.05），治疗方法、时间在NIHSS评分上主效应显著（P＜0.05）；术后2、4周微创组NIHSS评 分低于开颅组（P＜0.05）。术后，两组血清NSE、NPY水平分别低于本组术前，血清BDNF水平分别高于本组术前 （P＜0.05）；术后，微创组血清NSE、NPY水平低于开颅组，血清BDNF水平高于开颅组（P＜0.05）。出院时，两组 定向力、语言功能、延迟记忆能力、即刻记忆能力、注意力和计算力维度得分及MMSE总分分别高于本组入院时，且 微创组高于开颅组（P＜0.05）。微创组术后并发症总发生率低于开颅组（P＜0.05）。结论　与传统开颅手术比较， CT定位配合微创血肿清除术可缩短高血压脑出血患者术后自动睁眼时间及入住ICU时间，对神经功能的影响较小，可 改善患者认知功能，减少术后并发症的发生，但血肿清除率较低。

Abstract：

Objective To compare the effect of CT localization combined with minimally invasive hematoma evacuation and traditional craniotomy in the treatment of patients with hypertensive intracerebral hemorrhage. Methods A total of 103 hypertensive intracerebral hemorrhage patients admitted to Yixing Hospital of Traditional Chinese Medicine from March 2017 to March 2022 were selected as the research objects. The patients were randomly divided into craniotomy group (n=51) and minimally invasive group (n=52) using the envelope method. The craniotomy group received traditional craniotomy treatment, while the minimally invasive group received CT localization combined with minimally invasive hematoma evacuation. The surgical situation (hematoma clearance rate, postoperative automatic eye opening time, intraoperative bleeding volume) , and ICU stay time were compared between the two groups, National Institute of Health Stroke Scale (NIHSS) was used to evaluate the neurological function before surgery, and at 1 week after surgery, 2 weeks after surgery, and 4 weeks after surgery, the levels of serum neuron-specific enolase (NSE) , neuropeptide Y (NPY) and brain-derived neurotrophic factor (BDNF) were compared between the two groups before surgery and at 3 days after surgery, Mini-Mental State Examination (MMSE) was used to evaluate the cognitive function at admission and discharge, and the occurrence of postoperative complications was recorded. Results The hematoma clearance rate in the minimally invasive group was lower than that in the craniotomy group, the postoperative automatic eye opening time, and ICU stay time were shorter than those in the craniotomy group and intraoperative bleeding volume was less than that in the craniotomy group (P < 0.05) . There was an interaction between treatment methods and time on the NIHSS score (P < 0.05) . The main effect of treatment methods and time on the NIHSS score was significant (P < 0.05) . The NIHSS scores in the minimally invasive group were lower than those in the craniotomy group at 2 weeks and 4 weeks after surgery (P < 0.05) . After surgery, the serum levels of NSE and NPY in the two groups were lower than those before surgery, the serum level of BDNF was higher than that before surgery, respectively (P < 0.05) ; after surgery, the serum levels of NSE and NPY in minimally invasive group were lower than those in craniotomy group, the level of BDNF was higher than that in craniotomy group (P < 0.05) . At discharge, the scores of directional ability, language function, delayed memory ability, immediate memory ability, attention and computational ability items, and the total score of MMSE in the two groups were higher than those at admission, respectively, and those in minimally invasive group were higher than those in craniotomy group (P < 0.05) . The total occurrence of postoperative complications in the minimally invasive group was lower than that in the craniotomy group (P < 0.05) . Conclusion Compared with traditional craniotomy, CT localization combined with minimally invasive hematoma evacuation can shorten the postoperative automatic eye opening time and ICU stay time of patients with hypertensive intracerebral hemorrhage with minimal impact on neurdogical function, improve cognitive function, and reduce postoperative complications, but the hematoma removal rate is relatively low.

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