【摘要】 目的 比较神经内镜与脑室外引流(EVD)治疗中到大量脑室出血的疗效,并分析对脑损伤程度的影响。方法 选取2021年6月至2023年6月汉中市中心医院神经外科收治的中到大量脑室出血患者102例作为研究对象,按照随机数字表法分为观察组(n=51)和对照组(n=51)。观察组在神经内镜下行脑室内血肿清除术,对照组行常规EVD。比较两组血肿清除率、手术相关指标、手术前后炎症因子[C反应蛋白(CRP)、白细胞介素-1β (IL-1β)、肿瘤坏死因子-α (TNF-α)]、脑损伤因子[血清神经元特异性烯醇化酶(NSE)、S100β蛋白(S100β)、胶质纤维酸性蛋白(GFAP)]、神经功能[美国国立卫生研究院卒中量表(NIHSS)]、日常活动能力(ADL)评分及并发症发生率。结果 观察组血肿清除率优于对照组(P<0.05);观察组手术时间长于对照组,术中出血量高于对照组,引流管拔除时间、脑脊液复常时间、住院时间较对照组短(P<0.05);观察组术后1d、3d血清TNF-α、IL-1 β、CRP、NSE、S100 β、GFAP水平高于对照组(P<0.05);术后3个月观察组NIHSS评分低于对照组,ADL评分高于对照组(P<0.05);两组并发症总发生率比较差异无统计学意义(P>0.05)。结论 神经内镜手术治疗中到大量脑室出血效果显著,预后效果好,但创伤较大,而EVD虽然创伤小,但是效果欠佳。更多还原

【Abstract】 Objective To compare the efficacy of neuroendoscopy and external ventricular drainage(EVD) in the treatment of moderate to massive ventricular hemorrhage,and analyze the impact on the degree of brain injury.Methods A total of 102 patients with moderate to large ventricular hemorrhage admitted to the Department of Neurosurgery,Hanzheng Central Hospital from June 2021 to June 2023 were selected as the research subjects and randomly divided into an observation group(n=51) and a control group(n=51).The observation group underwent endoscopic removal of intraventricular hematoma,while the control group underwent routine EVD.The hematoma clearance rate,surgical-related indicators,pre-and post-operative inflammatory factors [C-reactive protein(CRP),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)],brain injury factors [serum neuron-specific enolase(NSE),S100βprotein(S100β),glial fibrillary acidic protein(GFAP)],neurological function(NIHSS score),daily activity ability(ADL) score,and complication rate were compared between the two groups.Results The hematoma clearance rate in the observation group was superior to that in the control group(P <0.05);the operation time in the observation group was longer than that in the control group,and the intraoperative blood loss was higher than that in the control group,but the drainage tube removal time,cerebrospinal fluid recovery time,and hospitalization time were shorter than those in the control group(P<0.05);the levels of serum TNF-α,IL-1β,CRP,NSE,S100β,and GFAP in the observation group were higher than those in the control group on postoperative day 1 and 3(P <0.05);the NIHSS score in the observation group was lower than that in the control group,and the ADL score was higher than that in the control group(P <0.05);there was no significant difference in the incidence of complications between the two groups(P> 0.05).Conclusion The treatment of moderate to massive ventricular hemorrhage with neuroendoscopic surgery has significant effects and good prognosis,but the trauma is relatively large.Although EVD has less trauma,the effect is not good.更多还原