目的 观察神经内镜微创手术治疗脑室出血铸型患者的临床疗效.方法 采用前瞻性非随机对照研究,选取2020年1月至2023年1月在该院神经外科住院手术治疗的脑室出血铸型患者68例为研究对象,采用神经内镜微创手术的34例患者设为观察组,采用侧脑室钻孔引流术的34例患者设为对照组;观察两组患者手术时间、术中出血量、住院时间、重症监护病房时间、术后脑室血肿廓清时间、术后脑积水的发生情况、术后术区再出血发生率、术后并发症发生率;检测术前、术后7 d血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、胶质纤维酸性蛋白(GFAP)、中枢神经系统特异性蛋白(S100-β)、神经元特异性烯醇化酶(NSE)的表达水平;观察术前、术后14 d格拉斯哥昏迷评分(GCS)、改良巴氏指数(BI)、美国国立卫生院卒中量表(NIHSS)评分;观察术后6个月格拉斯哥预后评分(GOS).结果 对照组手术时间、术中出血量明显低于观察组(P＜0.05);观察组住院时间、重症监护病房时间、术后脑室血肿廓清时间和术后脑积水发生率明显短于或低于对照组(P＜0.05);两组患者术后术区再出血发生率差异无统计学意义(P＞0.05);观察组肺部感染、泌尿道感染、深静脉血栓形成和手术部位感染发生率明显低于对照组(P＜0.05),两组患者脏器功能障碍发生率差异无统计学意义(P＞0.05);两组患者术后7 d TNF-α、IL-6、CRP、GFAP、S100-β、NSE较术前明显降低(P＜0.05);观察组明显低于对照组(P＜0.05);两组患者术后14 d GCS、BI、NIHSS评分较术前明显改善(P＜0.05);观察组明显优于对照组(P＜0.05);观察组术后6个月GOS明显低于对照组(P＜0.05).结论 神经内镜微创手术治疗脑室出血铸型疗效确切、术后并发症发生率低,值得临床推广.
Objective To observe the clinical effect of neuroendoscopic minimal invasive surgery in treating the patients with intraventricular hemorrhage cast.Methods The prospective non-randomized con-trolled study was adopted.Sixty-eight inpatients with intraventricular hematoma cast receiving surgical treat-ment in the neurosurgery department of this hospital from January 2020 to January 2023 were selected as the study subjects;thirty-four cases adopting neuroendoscopic minimal invasive surgery served as the observation group and 34 cases adopting lateral ventricle drilling drainage served as the control group;the surgical time,in-traoperative bleeding volume,hospitalization duration,ICU duration,clearance time of postoperative ventricle hematoma,postoperative hydrocephalus occurrence,occurrence rate of recurrent bleeding in operating area and postoperative complications occurrence rate were observed in the two groups.The levels of serum TNF-α,L-6,CRP,GFAP,S100-β and NSE before operation and on postoperative 7 d were detected;the GCS scores,BI,NIHSS scores before operation and on postoperative 14 d were observed;the GOS scores in postoperative 6 months were observed.Results The surgical time and intraoperative bleeding amount in the control group were significantly less than those in the observation group(P＜0.05);the hospitalization duration,ICU dura-tion,clearance time of postoperative ventricular hematoma and incidence rate of hydrocephalus in the observa-tion group were significantly short or less than those in the control group(P＜0.05);there was no statistical-ly significant difference in postoperative rebleeding incidence rate between the two groups(P＞0.05);the in-cidence rates of pulmonary infection,urinary tract infection,deep venous thrombosis and surgical site infection in the observation group were significantly less than those in the control group(P＜0.05);there was no sta-tistically significant difference in organ dysfunction incidence rate between the two groups(P＞0.05);the lev-els of postoperative TNF-α,L-6,CRP,GFAP,S100-β and NSE in the both groups were significantly decreased compared with those before operation(P＜0.05);the observation group was significantly lower than the con-trol group(P＜0.05);the GCS,BI and NIHSS scores on postoperative 14 d in the two groups were signifi-cantly improved compared with before operation(P＜0.05);the observation group was significantly better than the control group(P＜0.05);the GOS score at postoperative 6 months in the observation group was bet-ter than that in the control group(P＜0.05).Conclusion Neuroendoscopic minimally invasive surgery is ef-fective in treating intraventricular hemorrhage cast with low incidence rate of postoperative complications,which is worthy of clinical promotion.
袁淼;曾令勇;翟安林;苟志勇;王帆;朱黎
四川绵阳四0四医院/川北医学院附属第二医院神经外科,四川绵阳 621000
临床医学
神经内镜;微创;侧脑室;引流;脑室出血
neuroendoscope;minimally invasion;lateral ventricle;drainage;intraventricular hemorrhage
《重庆医学》 2024 (013)
1966-1971 / 6
四川省科技厅应用基础研究项目(2017JY0035).
10.3969/j.issn.1671-8348.2024.13.008
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