摘要:
Objective To investigate the therapeutic effect and inflammatory expression in keyhole craniotomy hematoma clearance curing the hypertensive putaminal hemorrhage.Methods Selected 112 patients of hypertensive putaminal hemorrhage in department of neurosurgery of the Second Affiliated Hospital of the North Sichuan Medical College between January 2011 and January 2017,they were divided into two groups depending on the operation;control group was operated through stereotaxic hematoma puncture drainage,experiment group was operated through keyhole craniotomy hematoma clearance;The therapeutic effect,post-operation complications and the Glasgow Outcome Scale (GOS),the inflammatory factor before and after the operation were compared.Results The therapeutic effect between the two groups is significant (P <0.05):Intracranial edema duration (t =5.117,P =0.001),Paralysis limb recovery time (t =3.953,P =0.003),Consciousness recovery (t =4.294,P =0.002),ICU hospitalization time (t =5.872,P =0.000);CRP,TNFα,IL-6 expressions reduce after the operation(P <0.05),the difference between the two groups is significant(P <0.05);Compared before and after surgery,CRP were as follow:the control group (F =61.030,P =0.000),the experimental group (F =64.684,P =0.000),Postoperative comparison between two groups (F =4.478,P =0.049);Compared before and after surgery,TNFαtas follow:the control group (F =75.686,P =0.000),the experimental group (F =51.150,P =0.000),Postoperative comparison between two groups (F =5.550,P =0.030);Compared before and after surgery,IL-6 as follow:the control group (F =39.125,P =0.000),the experimental group (F =126.189,P =0.000),Postoperative comparison between two groups (F =7.314,P =0.015);The post-operation complications between the two groups is significant (P < 0.05);Rebleeding (x2 =3.893,P =0.049),Intracranial infection (x2 =3.893,P =0.049),Lung infection (x2 =5.508,P =0.015),Urinary infection (x2 =4.807,P =0.024);The difference of GOS between the two groups is significant (x2 =3.972,P =0.036).Conclusion Keyhole craniotomy hematoma is effective in treating the hypertensive putiminal hemorrhage which can increase the therapeutic effect,reduce the post-operation complication.%目的 观察锁孔入路开颅血肿清除术治疗老年高血压性壳核出血临床疗效及其对炎性因子表达的影响.方法 选择2011年1月-2017年1月四川省绵阳市404医院(川北医学院附属第二医院)神经外科手术治疗的> 60岁高血压性壳核出血患者112例作为研究对象,根据手术方式不同分为2组.对照组50例采用立体定向血肿穿刺引流术,观察组62例采用锁孔入路开颅血肿清除术,观察术后2组患者临床疗效、术后并发症及格拉斯哥预后评分(GOS);所有患者于术前,术后3d、14 d采集患者静脉血标本检测炎性因子表达.结果 与对照组比较,观察组术后颅内水肿持续时间明显缩短、瘫痪肢体恢复早、意识恢复快、ICU留置时间短(t=5.117、3.953、4.294、5.872,P=0.001、0.003、0.002、0.000).术后2组患者CRP、TNF-α、IL-6表达均较术前降低(对照组F=61.030、75.686、39.125,P均=0.000;观察组F=64.684、51.150、126.189,P均=0.000),但观察组术后降低更明显(P<0.05).观察组术后再出血及颅内、肺部、尿路感染例数均明显低于对照组(P<0.05).术后3个月随访,观察组患者GOSⅣ级明显优于对照组(x2=3.972,P=0.036).结论 对于老年高血压壳核出血患者,锁孔入路血肿清除术临床疗效及预后佳,术后并发症发生率低.