精准定位下内镜手术治疗老年脑出血临床观察
田 齐 陈熙龙 贾海莉
河北北方学院附属第一医院，河北 张家口 075000
通信作者：贾海莉
【摘要】 目的 探究精准定位下内镜手术治疗老年脑出血短期预后危险因素及其对炎症反应、应激反应的影响。方法 回顾性连续纳入河北北方学院附属第一医院 2017-02—2019-04 收治的 62 例老年脑出血患者，研究组 29 例和对照组 33 例，其中研究组应用开源软件辅助神经内镜血肿清除术，对照组应用传统开颅血肿清除术。于术前、术后 7 d 检测 2 组患者血肿体积、美国国立卫生研究院卒中量表（NIHSS）评分、炎症反应指标［白细胞介素-8（IL-8）、正五聚蛋白 3（PTX3）、血管细胞黏附分子（VCAM1）、核因子-κB（NF-κB）］及应激反应指标［丙二醛（MDA）、过氧化物酶体增殖物激活受体γ（PPARγ）、活性氧（ROS）、缺血修饰清蛋白（IMA）］，分析研究组各影响因素和短期预后之间的相关性。结果 术后 7 d，研究组与对照组 NF-κB、VCAM1、PTX3、IL-8（0.97±0.16 vs 1.59±0.30，40.25±4.51 vs 56.21±6.53，2.80±0.40 vs 4.17±0.68，42.20±4.59 vs 65.15±6.57）均出现显著升高，研究组低于对照组（P<0.01）。2 组 IMA、ROS、PPARγ、MAD（83.08±8.36 vs 97.62±9.36，9.12±1.23 vs 15.92±2.33，2.18±0.45 vs 3.11±0.77，5.90±0.61 vs 9.92±1.03）均显著升高，研究组低于对照组（P<0.01）。2 组 NIHSS 评分、血肿体积（8.96±1.92 vs 12.29±2.35，4.28±0.41 vs 8.91±1.59）均出现显著降低，且研究组低于对照组（P<0.01）。对研究组患者临床资料进行分析发现，血肿未破入脑室、出血量＜50 mL、入院 GCS 评分＞5 分以及年龄 60~69 岁的患者预后较好。Logistic回归分析显示，血肿破入脑室、出血量≥50 mL、入院 GCS 评分＜5 分以及年龄 70~80 岁是影响接受精准定位下内镜手术治疗的老年脑出血患者预后的危险因素。结论 精准定位下内镜手术对老年脑出血患者血肿清除程度高，且可有效减轻由手术创伤激发的全身炎症、应激反应，而其影响预后的独立因素包括血肿破入脑室、出血量≥50 mL、入院 GCS 评分＜5 分以及年龄 70~80 岁。
【关键词】 老年脑出血；精准定位下内镜手术；短期预后；危险因素；神经功能；炎症应激反应
【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1673-5110 （2022） 05-0593-06
基金项目：河北省卫生健康委员会科研基金项目（编号：20220598）
DOI：10.12083/SYSJ.220187
Clinical observation of endoscopic surgery under precise positioning in the treatment of senile intracerebral hemorrhage
TIAN Qi，CHEN Xilong，JIA Haili
The First Affiliated Hospital of Hebei North College，Zhangjiakou 075000，China
Corresponding author：JIA Haili
【Abstract】 Objective To investigate the short-term prognostic risk factors of endoscopic surgery under precise positioning for elderly cerebral hemorrhage and its effects on inflammatory response and stress response. Methods Retrospectively included 62 elderly patients with cerebral hemorrhage admitted from February 2017 to April 2019 in ourHospital，and divided them into a research group（29 cases）and a control group（33 cases）according to the surgical method. Open source software was used to assist neuroendoscopic hematoma removal in research group，and the control group used traditional craniotomy hematoma removal. Before operation and 7 days after operation，the volume of hematoma，NIHSS score，inflammatory response indexes of intergroup-8（IL-8），pentraxin 3（PTX3）were detected），Vascular cell adhesion molecule（VCAM1），nuclear factor-κB（NF-κB）］and stress response indicators [malondialdehyde（MDA），peroxisome proliferator-activated receptor γ（PPARγ），reactive oxygen species（ROS），ischemia modified albumin（IMA）］.Analyze the correlation between the influencing factors of the endoscopy group and the short-term prognosis. Results 7 days after operation，NF-κB，VCAM1， PTX3，IL-8 in the study and control groups（0.97±0.16 vs 1.59±0.30，40.25±4.51 vs 56.21±6.53，2.80±0.40 vs 4.17±0.68，42.20±4.59 vs 65.15±6.57）were significantly increased，but the study group was lower than the control group（P<0.01）；IMA，ROS，PPARγ，MAD in the two groups（83.08±8.36 vs 97.62±9.36，9.12±1.23 vs 15.92± 2.33，2.18±0.45 vs 3.11±0.77，5.90±0.61 vs 9.92±1.03）were significantly increased，but the study group was lower than the control group（P<0.01）；NIHSS score and Hematoma volume of both groups（8.96±1.92 vs 12.29±2.35， 4.28±0.41 vs 8.91±1.59）were significantly reduced，and the study group was lower than the control group（P< 0.01）；analysis of clinical data of 29 elderly patients with cerebral hemorrhage in the endoscopic group found that the hematoma did not break into the ventricle，patients with bleeding volume <50 mL，admission GCS score> 5， and patients aged 60-69 years had a better prognosis. Logistic regression analysis showed that the hematoma broke into the ventricle，the bleeding volume ≥50 mL，the admission GCS score ＜5 points，and the age was 70-80 years old，which were risk factors affecting the prognosis of elderly patients with cerebral hemorrhage who underwent precise positioning endoscopic surgery. Conclusion Endoscopic surgery under precise positioning has a high degree of hematoma clearance in elderly patients with cerebral hemorrhage，and can effectively reduce systemic inflammation and stress response triggered by surgical trauma，and its independent factors affecting prognosis include hematoma broken into the ventricle，hemorrhage ≥50 mL，admission GCS score <5 points and age 70-80 years.
【Key words】 Elderly cerebral hemorrhage；Precise positioning endoscopic surgery；Short-term prognosis；Risk factors；Nervefunction；Inflammatory stress response
