摘要
目的探讨亚低温疗法辅助立体定向血肿穿刺置管引流术对老年脑出血患者术后颅内压、神经功能和意识状况的保护作用。方法共116例老年脑出血患者随机接受立体定向血肿穿刺置管引流术(对照组,58例)和立体定向血肿穿刺置管引流术联合亚低温疗法(联合组,58例),监测颅内压、血清S-100B蛋白和血糖水平,欧洲卒中量表(ESS)评价神经功能,Glasgow昏迷量表(GCS)评价意识状况。结果两组术后颅内压升高,至术后3 d达峰值,随即下降,至术后7 d时仍高于术后即刻(对照组:t=55.232,P=0.000;t=74.233,P=0.000;t=67.583,P=0.000;t=59.642,P=0.000;t=52.852,P=0.000;t=45.865,P=0.000;联合组:t=28.765,P=0.000;t=54.233,P=0.000;t=33.402,P=0.000;t=27.379,P=0.000;t=16.122,P=0.000;t=7.444,P=0.000)。术后3、5和7 d血清S-100B蛋白(对照组:t=9.443,P=0.000;t=12.952,P=0.000;t=18.832,P=0.000;联合组:t=11.454,P=0.000;t=15.404,P=0.000;t=20.439,P=0.000)和血糖(对照组:t=11.580,P=0.000;t=14.592,P=0.000;t=17.482,P=0.000;联合组:t=12.343,P=0.000;t=15.231,P=0.000;t=19.631,P=0.000)均低于术后即刻。术后2、4、12、24和48周ESS评分高于术后即刻(对照组:t=30.533,P=0.000;t=39.273,P=0.000;t=43.853,P=0.000;t=48.924,P=0.000;t=53.322,P=0.000;联合组:t=38.943,P=0.000;t=43.595,P=0.000;t=49.923,P=0.000;t=52.594,P=0.000;t=58.943,P=0.000)。术后1和7 d GCS评分均高于术前(对照组:t=10.434,P=0.000;t=15.232,P=0.000;联合组:t=13.432,P=0.000;t=17.532,P=0.000)。而联合组患者颅内压(F=111.553,P=0.000)、血清S-100B蛋白(F=9.834,P=0.000)和血糖(F=8.094,P=0.001)低于,ESS评分(F=10.689,P=0.000)和GCS评分(F=7.343,P=0.007)高于对照组。两组患者病死率差异无统计学意义[6.90%(4/58)对5.17%(3/58);校正χ2=0.000,P=1.000],无一例发生硬膜外血肿和颅内感染等并发症。结论亚低温疗法辅助立体定向血肿穿刺置管引流术可以降低老年脑出血患者颅内压,改善神经功能和意识状况,值得临床推广应用。
Objective To analyze the effect of mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage on postoperative intracranial pressure(ICP) and neuroprotection in elderly patients with intracerebral hemorrhage(ICH). Methods A total of 116 elderly ICH patients randomly underwent stereotactic hematoma puncture and catheter drainage(control group, N = 58) and mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage(combination group, N = 58).ICP, serum S-100 B protein(S-100 B) and blood glucose were monitored. European Stroke Scale(ESS) was used to evaluate neurological function, and Glasgow Coma Scale(GCS) was used to assess conscious state.Results ICP increased after operation, and reached the peak on the 3 rd day, and then decreased, but was still higher than immediately after operation on the 7 th day in both groups(control group: t = 55.232, P =0.000; t = 74.233, P = 0.000; t = 67.583, P = 0.000; t = 59.642, P = 0.000; t = 52.852, P = 0.000; t = 45.865,P = 0.000; combination group: t = 28.765, P = 0.000; t = 54.233, P = 0.000; t = 33.402, P = 0.000; t = 27.379,P = 0.000; t = 16.122, P = 0.000; t = 7.444, P = 0.000). The serum S-100 B(control group: t = 9.443, P =0.000; t = 12.952, P = 0.000; t = 18.832, P = 0.000; combination group: t = 11.454, P = 0.000; t = 15.404, P =0.000; t = 20.439, P = 0.000) and blood glucose(control group: t = 11.580, P = 0.000; t = 14.592, P = 0.000;t = 17.482, P = 0.000; combination group: t = 12.343, P = 0.000; t = 15.231, P = 0.000; t = 19.631, P = 0.000)on the 3 rd, 5 th and 7 th day in both groups were significantly lower than immediately after operation. The ESS scores 2, 4, 12, 24 and 48 weeks after operation were significantly higher than immediately after operation(control group: t = 30.533, P = 0.000; t = 39.273, P = 0.000; t = 43.853, P = 0.000; t = 48.924, P =0.000; t = 53.322, P = 0.000; combination group: t = 38.943, P = 0.000; t = 43.595, P = 0.000; t = 49.923, P =0.000; t = 52.594, P = 0.000; t = 58.943, P = 0.000). The GCS score on the 1 st and 7 th day after operation were significantly higher than before operation in both groups(control group: t = 10.434, P = 0.000; t =15.232, P = 0.000; combination group: t = 13.432, P = 0.000; t = 17.532, P = 0.000). Compared with control group, ICP(F = 111.553, P = 0.000), serum S-100 B(F = 9.834, P = 0.000) and blood glucose(F = 8.094, P =0.001) were significantly lower, while ESS score(F = 10.689, P = 0.000) and GCS score(F = 7.343, P =0.007) were significantly higher in combination group. There was no significant difference on the mortalitybetween 2 groups [6.90%(4/58) vs. 5.17%(3/58); adjusted χ~2= 0.000, P = 1.000]. No patient suffered from epidural hematoma or intracranial infection. Conclusions Mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage can significantly reduce ICP in elderly ICH patients, and improve the neurological function and conscious state.
作者
向开诚
罗义华
XIANG Kai-cheng;LUO Yi-hua(Department of Neurosurgery,Dazhou Integrated TCM and Western Medicine Hospital,Dazhou 635000,Sichuan,China)
出处
《中国现代神经疾病杂志》
CAS
北大核心
2018年第12期869-875,共7页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
脑出血
引流术
立体定位技术
低温
人工
Cerebral hemorrhage
Drainage
Stereotaxic techniques
Hypothermia
induced
