【作者】 赵鹏；

【导师】 孙昭胜；

【作者基本信息】 河北医科大学 ， 外科学（专业学位）， 2022， 硕士

【摘要】 目的:探讨神经内镜下血肿清除术在治疗高血压脑出血(Hypertensive intracerebral hemorrhage,HICH)中的临床疗效及其对炎症因子水平的影响。方法:回顾性分析衡水市人民医院神经外科自2019年11月至2021年12月收治的高血压脑出血患者80例,根据手术治疗方案的不同分为开颅组(42例)与内镜组(38例)。比较两组患者的手术时长、术后残余血肿量、血肿量清除率、术后并发症、术后3个月的GOS评分以及术后3、7天的炎症因子水平情况,并进行数据统计分析。结果:1.两组患者的一般资料及基线情况比较:两组患者在年龄、性别、手术前的GCS评分以及术前血肿量方面,差异无统计学意义(P>0.05)。2.两组患者的手术情况比较:内镜组手术时长125.37±13.09min,开颅组为145.95±17.20min;内镜组残余血肿量为5.11±2.77ml,开颅组为8.10±3.78ml;内镜组血肿清除率89.74±6.01%,开颅组为83.09±9.23%,差异均有统计学意义(P<0.05);神经内镜血肿清除术手术时间较短,血肿清除率高。3.两组患者术后并发症比较:在颅内再出血、颅内感染、肺部感染、电解质紊乱方面:内镜组为4人(10.52%),4人(10.53%),12人(31.58%),11人(28.95%);开颅组为6人(14.29%),8人(19.05%),19人(45.24%),17人(40.48%);在颅内再出血方面,差异无统计学意义(P>0.05);其余方面,差异有统计学意义(P<0.05)。由此可见,神经内镜血肿清除减压术的术后并发症较少。4.两组患者血清炎症因子水平的比较:两组患者在术后3天和7天较术前均有增高,但内镜组低于开颅组,差异有统计学意义(P<0.05)。神经内镜下血肿清除术可抑制或减轻急炎症因子的增加,对改善脑损伤、减少炎症反应有积极影响。5.两组患者预后情况比较:内镜组预后良好17人(44.74%),开颅组预后良好14人(33.33%),内镜组高于开颅组,差异有统计学意义(P<0.05)。结论:神经内镜下血肿清除术治疗HICH患者,手术时间短,血肿清除率高,炎症反应减轻,术后并发症少,患者预后良好。更多还原

【Abstract】 Objective: To investigate the clinical efficacy of endoscopic hematoma evacuation and craniotomy for hematoma decompression in the treatment of hypertensive intracerebral hemorrhage(HICH)and the effects of the two surgical methods on the levels of inflammatory factors.Methods: This study retrospectively analyzed 80 patients with hyper-tensive intracerebral hemorrhage(the bleeding site was located in the basal ganglia)admitted to the Department of Neurosurgery of Hengshui People’s Hospital from November 2019 to December 2021.They were divided into craniotomy group according to different surgical treatment plans.(42 cases)and endoscopy group(38 cases).The operation time,postoperative residual hematoma volume,hematoma volume clearance rate,postoperative complications(intracranial rebleeding,intracranial infection,pulmonary infection,electrolyte disturbance)and Glasgow outcome score 3 months after surgery were compared between the two groups,(Glasgow outcome scale,GOS)and inflammatory factor levels before surgery,3 and 7 days after surgery,and statistical analysis of the data.Results:1.Comparison of general information and baseline conditions between the two groups of patients: There was no significant difference in age,gender,preoperative Glasgow Coma Scale(GCS)and preoperative hematoma volume between the two groups(P>0.05).2.Comparison of the operation time,postoperative residual hematoma and hematoma clearance rate between the two groups: the operation time of the endoscopic group was 125.37±13.09 min,the craniotomy group was145.95±17.20min;the residual hematoma volume of the endoscopic group was 5.11±2.77 ml,The craniotomy group was 8.10±3.78ml;the hematoma clearance rate in the endoscopic group was 89.74±6.01%,and that in the craniotomy group was 83.09±9.23%,with statistical significance(P<0.05).Shorter,less residual hematoma after operation,and high hematoma clearance rate.Comparison of postoperative complications between the two groups: in terms of intracranial rebleeding,the endoscopic group was lower than the craniotomy group,but the difference was not statistically significant(P>0.05);in terms of intracranial infection,pulmonary infection,and water and electrolyte disturbances,neuroendoscopic hematoma decompression had fewer postoperative complications,and the difference was statistically significant(P<0.05).3.Comparison of postoperative complications between the two groups: in terms of intracranial rebleeding,intracranial infection,pulmonary infection,and electrolyte disturbance: 4 patients(10.52%),4 patients(10.52%),12patients(31.58%),11(28.95%);craniotomy group was 6(14.29%),8(19.05%),19(45.24%),17(40.48%);in terms of intracranial rebleeding,The endoscopic group was lower than the craniotomy group,but the difference was not statistically significant(P>0.05);in terms of intracranial infection,pulmonary infection,and electrolyte disturbance,the endoscopic group was lower than the craniotomy group,and the difference was statistically significant(P<0.05).It can be seen that,in terms of intracranial infection,pulmonary infection,and water and electrolyte disturbance,neuroendoscopic hematoma decompression surgery has fewer postoperative complications.4.Comparison of prognosis between the two groups: 17 patients(44.74%)in the endoscopic group had a good prognosis,and 14 patients(33.33%)in the craniotomy group had a good prognosis.The endoscopic group was higher than the craniotomy group,and the difference was statistically significant(P<0.05).Conclusions: Neuroendoscopic hematoma evacuation in the treatment of HICH patients has a short operation time,high hematoma clearance rate,less inflammatory response,less postoperative complications,and a good prognosis.更多还原