目的 探讨微创穿刺引流对血脑屏障(BBB)功能的影响及机制.方法 选择浙江省嘉兴市第二医院神经外科收治的92例高血压脑出血(HICH)患者,按随机数字表法分为对照组和观察组,每组46例.对照组行常规开颅血肿清除术,观察组行微创穿刺引流术.采用美国国立卫生研究院卒中量表(NIHSS)评价患者的神经功能,用酶联免疫吸附试验(ELISA)检测血清髓鞘碱性蛋白(MBP)水平,用电化学发光法测定血清中枢神经特异蛋白S100水平,用全自动生物分析仪测定血清及脑脊液白蛋白水平,并计算BBB指数,术后14 d观察患者临床疗效和并发症发生情况.结果 两组术后NIHSS评分均较术前明显降低,且观察组的降低程度较对照组更显著(分:3.68±2.39比5.43±3.89,P<0.05);两组术后MBP、S100和脑脊液白蛋白及BBB指数均较术前升高,但观察组变化值不及对照组显著〔MBP(μg/L):3.02±0.28比3.81±0.29,S100(μg/L):0.95±0.24比1.34±0.27,脑脊液白蛋白(μg/L):9.89±0.78比21.43±1.14,BBB指数:0.22±0.04比0.48±0.05〕,差异均有统计学意义(均P<0.05);两组间血清白蛋白水平比较差异均无统计学意义(均P>0.05).观察组患者总有效率明显高于对照组〔84.78%(39/46)比65.22%(30/46),χ2=4.696,P=0.030〕,伤口感染、消化道出血等并发症发生率明显低于对照组〔13.04%(6/46)比36.96%(17/46),χ2=4.120,P=0.042〕.结论 微创穿刺引流治疗HICH患者临床疗效显著,可保护患者神经功能和BBB功能,降低并发症的发生.%Objective To explore the influence of minimally invasive puncture drainage on blood brain barrier (BBB) function and its mechanism.Methods Ninety-two patients with hypertensive intra-cerebral hemorrhage (HICH) in the Department of Neurosurgery of Jiaxing Affiliated Second Hospital of Zhejiang Province were divided into a control group and an observation group, according to random number table method, 46 cases in each group. In the control group, the conventional craniotomy was performed, while in the observation group, minimally invasive puncture drainage was carried out to remove the hematoma. The National Institute of Health Stroke Scale (NIHSS) were used to evaluate the neural function, the level of serum myelin basic protein (MBP) was detected by enzyme linked immunosorbent assay (ELISA), the central nervous specific serum protein S100 level was measured by electrochemical luminescence method, the albumin levels in serum and cerebrospinal fluid were determined by automatic biological analyzer, and the BBB index was calculated. After 14 days of surgery, the curative effect and incidence of complications of two groups were observed.Results After surgery, the NIHSS scores of two groups were obviously lower than those before surgery, and the degree of descent in observation group was more significant than that in the control group (score: 3.68±2.39 vs. 5.43±3.89,P < 0.05); after surgery, the levels of MBP, S100, albumin in cerebrospinal fluid and BBB in two groups were higher than those before surgery [MBP (μg/L): 3.02±0.28 vs. 3.81±0.29, S100 (μg/L): 0.95±0.24 vs. 1.34±0.27, cerebrospinal fluid albumin (μg/L): 9.89±0.78 vs. 21.43±1.14, BBB index: 0.22±0.04 vs. 0.48±0.05], the differences being statistically significant (allP < 0.05), but the change values in the observation group were less significant than those in the control group. The total effective rate in observation group was significantly higher than that in the control group [84.78% (39/46) vs. 65.22% (30/46),χ2 = 4.696,P = 0.030]. The incidence of wound infection, gastrointestinal bleeding in observation group was markedly lower than that in the control group [16.67% (6/46) vs. 36.96% (17/46), χ2 = 4.120,P = 0.042].Conclusion The minimally invasive puncture drainage has unequivocal clinical curative effect in treatment of patients with HICH, it can protect the nerve and BBB functions and reduce the incidence of complications.
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