立体定向软通道穿刺术对高血压脑出血患者应激状态及脑血流的影响

摘要

Objective To analyze the effect of stereotactic soft channel puncture in the treatment of hypertensive in -tracerebral hemorrhage , analyzes its influence on the stress state of patients and cerebral blood flow .Methods 160 cases of hypertensive cerebral hemorrhage were randomly divided into 2 groups, the observation group and the control group with 80 ca-ses in each group .The control group was treated with conventional craniotomy treatment , observation group received stereotac-tic puncture of soft channel .The therapeutic effect was compared between the 2 groups, and to observe oxidative stress related indicators, including superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-PX), a product of lipid peroxidation ( LPO) and total antioxidative capacity ( TAC) and middle cerebral artery blood flow parameters including peak systolic velocity diastolic blood pressure (PSV), end diastolic velocity (EDV), blood flow velocity (Vm), pulsatility index ( PI) and resistance index ( RI) of the change .Results There were no significant differences between the two groups after the treatment of first, 3rd, and 12th months of the therapeutic effect (85.00% vs.87.50%, 86.25% vs.88.75%, 93.75%vs.93.75%, P >0.05).Compared with before treatment, treatment for first day, patients in both of the 2 groups’ SOD, GSH -PX level were significantly decreased , MDA, LPO level and TAC value increased significantly ( P <0.05), and seventh days of treatment were recovered .Treatment for the first and 7th days later, serum MDA and LPO levels were sig-nificantly lower than those in the control group , SOD, GSH-PX level and TAC value was significantly higher than that in con-trol group ( P <0.05).Treatment for the first, 7th days, 2 groups of PSV, EDV, Vm, PI was significantly increased com-pared with those before treatment , RI decreased significantly ( P <0.05).Treatment for 1st, 7th days later,the patients in observation group’s PSV, EDV, Vm, PI were significantly higher than the control group , RI was significantly lower than that of the control group ( P <0 §.05 ) .Conclusion Compared with traditional craniotomy , by stereotactic soft channel puncture for the treatment of hypertensive cerebral hemorrhage has little influence on stress in patients with postoperative cerebral blood flow, quicker recovery advantages , and long-term curative effect is good .%目的：分析立体定向软通道穿刺术治疗高血压脑出血的疗效，分析其对患者应激状态和脑血流的影响。方法将160例高血压脑出血患者随机分为2组，对照组和观察组各80例。对照组患者采用常规开颅手术治疗，观察组则进行立体定向软通道穿刺术。比较2组间治疗效果，并观察氧化应激相关指标[包括超氧化物歧化酶（ SOD）、丙二醛（ MDA）、谷胱甘肽过氧化物酶（ GSH-PX）、脂质过氧化产物（ LPO）及总抗氧化能力（ TAC）]和大脑中动脉血流指标[包括收缩期峰值流速（PSV ）、舒张压末期血流速度（EDV）、血流速度（Vm）、血管搏动指数（PI）及阻力指数（RI）]的变化。结果治疗后第1、3、12个月2组间疗效均无显著差异（分别为85œ．00％vs．87．50％，86．25％ vs．88．75％，93．75％vs．93．75％， P ＞0．05）。与治疗前比较，治疗第1天2组患者SOD、GSH-PX水平显著降低，MDA、LPO水平和TAC值则显著升高（ P ＜0．05），而治疗第7天均有所恢复。治疗第1、7天后，观察组血清MDA和LPO水平显著低于对照组，SOD、GSH-PX水平和TAC值显著高于对照组（ P ＜0．05）。治疗第1、7天，2组PSV、EDV、Vm、PI与治疗前相比显著升高，RI则显著降低（ P＜0．05）。治疗1、7天后，观察组患者PSV、EDV、Vm、PI均显著大于对照组，RI则显著低于对照组（ P ＜0．05）。结论采用立体定向软通道穿刺术治疗高血压脑出血相比于传统开颅手术，具有对患者应激影响小，术后脑血流恢复快的优点，且长期疗效良好。