微创颅内血肿清除术对高血压脑出血患者的治疗作用及TCD评价

摘要

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods:A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols.The patients in the two groups were given drug conservative treatments.On this basis,the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle.TCD was performed before treatment,1 d,5 d,10 d,and 21 d after treatment.The hematoma and edema volume was calculated.NIHSS was used to evaluate the neurological function recovery.Results:Vs,Vd,and Vm after treatment in the minimally invasive group were significantly elevated (P<0.05),while PI was significantly reduced (P<0.05).Vs,Vd,and Vm after treatment in the conservative group were reduced first and elevated later,while PI was elevated first and reduced later,and reached the lowest/peak 10d after treatment.Vs,Vd,and Vm 5 d,10 d,and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group (P<0.05),while PI was significantly lower than that in the conservative group (P<0.05).The hematoma and edema volume after treatment in the two groups was significantly reduced (P<0.05).The hematoma and edema volume at each timing point was significantly lower than that in the conservative group (P<0.05).NIHSS score after treatment in the minimally invasive group was significantly reduced (P<0.05).NIHSS score in the conservative group was elevated first and reduced later,reached the peak 10d after treatment,and at each timing point was higher than that in the minimally invasive group (P<0.05).Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage,and contribute to the neurological function recovery.TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage,but also has a certain value in evaluating the prognosis of neurological function.%目的:探讨微创颅内血肿清除术对高血压脑出血患者的治疗作用,及动态TCD监测对患者神经功能恢复的预测价值.方法:选取我院收治的高血压脑出血患者70例,依据治疗方案不同分为微创组及保守组各35例;两组入院后均接受药物保守治疗,微创组同时行尿激酶联合YL-1型血肿穿刺针微创治疗,于治疗前及治疗后第1 d、5 d、10 d和21 d行TCD检测,计算血肿及水肿体积变化,并于各时间段行神经功能障碍评分(NIHSS)以评价神经功能恢复情况.结果:微创组治疗后各时间点TCD检测参数Vs、Vd、Vm逐渐升高,PI逐渐降低;保守组治疗后Vs、Vd、Vm先降低后升高,PI先升高后减低,且在治疗后第10 d达到低点/峰值;治疗后5 d、10 d、21 d微创组Vs、Vd、Vm高于保守组,PI低于保守组(P<0.05).治疗后两组脑血肿及水肿体积逐渐降低(P<0.05),微创组各时间点脑血肿及水肿体积明显低于保守组(P<0.05).治疗后微创组NIHSS评分逐渐下降,保守组NIHSS评分先升高后降低,于治疗后第10 d达到峰值,且各时间点均高于微创治疗(P<0.05).结论:早期微创手术可明显改善高血压脑出血患者血肿周围血流量,利于神经功能恢复,TCD不仅可以用于高血压脑出血患者脑血流量的动态变化监测,对患者神经功能预后具有一定评价价值.