不同时机微创颅内血肿穿刺引流术对高血压脑出血患者血清神经元特异性烯醇化酶、脑源性神经营养因子和同型半胱氨酸水平的影响
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摘要
目的探讨不同时机开展微创颅内血肿穿刺引流术治疗高血压脑出血病人(HICH)的疗效及对病人血清神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、同型半胱氨酸(Hcy)水平的影响。方法行微创颅内血肿穿刺引流术治疗的HICH病人200例。根据发病至手术时机分为4组:超早期组(时间<6 h) 23例,早期组(6～12 h) 52例,中期组(时间> 12～24 h) 96例和延期组(时间> 24 h) 29例。比较4组术后再出血率、近期预后,评价美国国立卫生研究院卒中量表(NIHSS)评分,测定血清NSE、BDNF、Hcy水平变化。结果超早期组和早期组的血肿完全清除率、预后良好率均显著高于中期组、延期组(P <0. 05),超早期组再出血率显著高于其余3组(P <0. 05)。术后14天、3个月、6个月,超早期组和早期组的NIHSS评分显著低于中期组、延期组(P <0. 05);超早期组和早期组术后血清NSE、Hcy水平显著低于中期组、延期组,BDNF显著高于中期组、延期组(P <0. 05)。结论微创颅内血肿穿刺引流术治疗HICH最佳手术时间窗为12小时内,在病情允许情况下越早手术临床预后越好,其机制可能与NSE、BDNF及Hcy水平变化有关。
Objective To investigate the efficacy of minimally invasive intracranial hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage( HICH) at different operation opportunities and its influence on the serum levels of neuron-specific enolase( NSE),brain-derived neurotrophic factor( BDNF) and homocysteine( Hcy). Methods The clinical data of 200 patients with HICH who treated with minimally invasive intracranial hematoma puncture and drainage were retrospectively analyzed. The patients were divided into four groups according to the time of operation: 23 cases as ultra-early group( < 6 h),52 cases as early group( 6 ～ 12 h),96 cases as mid-term group( > 12 ～ 24 h)and 29 cases as delayed group( > 24 h). The rate of postoperative rebleeding and the short-term prognosis were compared among the four groups,the scores of National Institutes of Health Stroke Scale( NIHSS) was evaluated,the changes of serum NSE,BDNF and Hcy levels were determined. Results The complete hematoma clearance rate and good prognosis rate in the ultra-early group and the early group were significantly higher than those in the mid-term group and deferred group( P < 0. 05). The rebleeding rate in the ultra-early group was significantly higher than that in the other three groups( P < 0. 05). After surgery,the serum levels of NSE and Hcy were significantly lower than the mid-term and delayed groups,while the BDNF was significantly higher than the two groups( P < 0. 05). Conclusion The optimal operation window of minimally invasive intracranial hematoma puncture and drainage for HICH is 12 hours after HICH.The earlier operation is more conducive to gain better clinical prognosis and can protect the cerebral nerve function,its mechanism may be related to the regulation of NSE,BDNF and Hcy levels.
Objective To investigate the efficacy of minimally invasive intracranial hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage( HICH) at different operation opportunities and its influence on the serum levels of neuron-specific enolase( NSE),brain-derived neurotrophic factor( BDNF) and homocysteine( Hcy). Methods The clinical data of 200 patients with HICH who treated with minimally invasive intracranial hematoma puncture and drainage were retrospectively analyzed. The patients were divided into four groups according to the time of operation: 23 cases as ultra-early group( < 6 h),52 cases as early group( 6 ～ 12 h),96 cases as mid-term group( > 12 ～ 24 h)and 29 cases as delayed group( > 24 h). The rate of postoperative rebleeding and the short-term prognosis were compared among the four groups,the scores of National Institutes of Health Stroke Scale( NIHSS) was evaluated,the changes of serum NSE,BDNF and Hcy levels were determined. Results The complete hematoma clearance rate and good prognosis rate in the ultra-early group and the early group were significantly higher than those in the mid-term group and deferred group( P < 0. 05). The rebleeding rate in the ultra-early group was significantly higher than that in the other three groups( P < 0. 05). After surgery,the serum levels of NSE and Hcy were significantly lower than the mid-term and delayed groups,while the BDNF was significantly higher than the two groups( P < 0. 05). Conclusion The optimal operation window of minimally invasive intracranial hematoma puncture and drainage for HICH is 12 hours after HICH.The earlier operation is more conducive to gain better clinical prognosis and can protect the cerebral nerve function,its mechanism may be related to the regulation of NSE,BDNF and Hcy levels.
引文
[1] Yang G,Shao G. Clinical effect of minimally invasive intracranial Hematoma in treating hypertensive cerebral hemorrhage[J]. Pak J Med Sci,2016,32(3):677-681.
[2]刘向哲,郭朋飞,王新志.颅内血肿微创穿刺清除术治疗高血压脑出血的Meta分析[J].中国中西医结合急救杂志,2017,24(3):257-261.
[3] Chi F,Lang T,Sun S,et al. Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage[J]. World J Emerg Med,2014,5(3):203-208.
[4]钟有安,肖开敏,钟良,等.颅内血肿微创穿刺清除术最佳手术时机的临床研究[J].微创医学,2013,8(1):36-37,75.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[6]胡均贤,徐春林,吴雅兰,等.高血压脑出血微创穿刺清除术后手术相关并发症及预后分析[J].临床外科杂志,2016,24(4):318.
[7]尹琪华,何建丽,宋志彬,等.颅内血肿微创引流术首次血肿抽吸率的探讨[J].中国急救医学,2017,37(4):359-364.
[8]姜曼玉,毕国荣.脑出血后血肿周围水肿:病理生理学机制和治疗策略[J].国际脑血管病杂志,2017,25(2):183-187.
[9]曾冉,王飞红,袁邦清,等.高血压脑出血不同手术方式及手术时机的比较[J].广东医学,2016,37(3):393-396.
[10]张文超,杨雪辉,郭昊,等.高血压脑出血患者立体定向微创颅内血肿清除术的最佳时机分析[J].山东医药,2017,57(20):92-95.
[11]段吉强,姚胜,王阳,等.不同手术时机治疗高血压脑出血的临床效果对比[J].中国医药导报,2018,15(2):71-74.
[12]刘宇明,邓燕华,许治强,等.脑出血患者血清NSE、GFAP、BDNF水平变化与认知障碍相关性研究[J].脑与神经疾病杂志,2016,24(10):623-626.
[13]宋晓洁,冯伟平,韩雪娇,等. IL-1β及BDNF水平变化与高血压脑出血患者脑水肿的关系[J].现代生物医学进展,2016,16(31):6144-6147.
[14]杨增烨,庞永斌,林小艳.高压氧对急性脑出血患者NSE、BDNF及sI CAM-1的影响及与脑水肿相关性研究[J].湖南师范大学学报(医学版),2016,13(6):139-142.
[15]王琨,王伟宁,宋波,等.微创颅内血肿抽吸术对高血压脑出血患者BNP、CRP、Hcy水平和生活质量的影响[J].河北医药,2018,40(4):526-530.
[16]郝小可,江小伟,宋洋,等.高血压性脑出血和血清同型半胱氨酸水平的关系[J].中国临床神经外科杂志,2017,22(4):219-221.
[2]刘向哲,郭朋飞,王新志.颅内血肿微创穿刺清除术治疗高血压脑出血的Meta分析[J].中国中西医结合急救杂志,2017,24(3):257-261.
[3] Chi F,Lang T,Sun S,et al. Relationship between different surgical methods,hemorrhage position,hemorrhage volume,surgical timing,and treatment outcome of hypertensive intracerebral hemorrhage[J]. World J Emerg Med,2014,5(3):203-208.
[4]钟有安,肖开敏,钟良,等.颅内血肿微创穿刺清除术最佳手术时机的临床研究[J].微创医学,2013,8(1):36-37,75.
[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[6]胡均贤,徐春林,吴雅兰,等.高血压脑出血微创穿刺清除术后手术相关并发症及预后分析[J].临床外科杂志,2016,24(4):318.
[7]尹琪华,何建丽,宋志彬,等.颅内血肿微创引流术首次血肿抽吸率的探讨[J].中国急救医学,2017,37(4):359-364.
[8]姜曼玉,毕国荣.脑出血后血肿周围水肿:病理生理学机制和治疗策略[J].国际脑血管病杂志,2017,25(2):183-187.
[9]曾冉,王飞红,袁邦清,等.高血压脑出血不同手术方式及手术时机的比较[J].广东医学,2016,37(3):393-396.
[10]张文超,杨雪辉,郭昊,等.高血压脑出血患者立体定向微创颅内血肿清除术的最佳时机分析[J].山东医药,2017,57(20):92-95.
[11]段吉强,姚胜,王阳,等.不同手术时机治疗高血压脑出血的临床效果对比[J].中国医药导报,2018,15(2):71-74.
[12]刘宇明,邓燕华,许治强,等.脑出血患者血清NSE、GFAP、BDNF水平变化与认知障碍相关性研究[J].脑与神经疾病杂志,2016,24(10):623-626.
[13]宋晓洁,冯伟平,韩雪娇,等. IL-1β及BDNF水平变化与高血压脑出血患者脑水肿的关系[J].现代生物医学进展,2016,16(31):6144-6147.
[14]杨增烨,庞永斌,林小艳.高压氧对急性脑出血患者NSE、BDNF及sI CAM-1的影响及与脑水肿相关性研究[J].湖南师范大学学报(医学版),2016,13(6):139-142.
[15]王琨,王伟宁,宋波,等.微创颅内血肿抽吸术对高血压脑出血患者BNP、CRP、Hcy水平和生活质量的影响[J].河北医药,2018,40(4):526-530.
[16]郝小可,江小伟,宋洋,等.高血压性脑出血和血清同型半胱氨酸水平的关系[J].中国临床神经外科杂志,2017,22(4):219-221.