本文選題：腦出血 + 微創(chuàng)手術(shù)��； 參考：《福建中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：探討“鎖孔”開顱血腫清除術(shù)和穿刺抽吸引流術(shù)兩種手術(shù)方法在治療基底節(jié)區(qū)高血壓腦出血(hypertensive intracerebral hemorrhage, HICH)療效的差別及與血清神經(jīng)元特異性烯醇化酶(neuron-specific enolase, NSE)水平變化相關(guān)性。方法：設(shè)立“鎖孔”開顱手術(shù)組,穿刺抽吸引流手術(shù)組和正常健康組。根據(jù)入組條件,選取基底節(jié)區(qū)HICH患者68例,根據(jù)手術(shù)方式分為“鎖孔”開顱血腫清除術(shù)組(以下稱鎖孔組)及穿刺抽吸引流組(以下稱穿刺組),隨機(jī)抽取健康對(duì)照組20例測(cè)定血清NSE水平。比較兩組患者手術(shù)時(shí)間、血腫清除率、手術(shù)并發(fā)癥、術(shù)中出血量及病死率差異。動(dòng)態(tài)測(cè)定并觀察鎖孔組和穿刺組患者術(shù)前、術(shù)后3d、7d、14d的血清NSE濃度變化,并相應(yīng)地在各時(shí)間點(diǎn)采用美國(guó)國(guó)立衛(wèi)生院卒中量表(NIH stroke scale, NIHSS)評(píng)定神經(jīng)功能缺損情況,分析血清NSE水平與NIHSS評(píng)分之間的相關(guān)性,術(shù)后28d時(shí)采用Barthel指數(shù)評(píng)估日常生活能力(Activities of daily living, ADL)以對(duì)比兩組間近期預(yù)后的差異。結(jié)果：1.兩組患者在手術(shù)時(shí)間、血腫清除率、術(shù)中出血量以及拔管時(shí)間方面均有顯著性差異(P0.05)。而在手術(shù)并發(fā)癥及病死率方面相比無顯著性差異(P0.05),但有鎖孔組的手術(shù)并發(fā)癥發(fā)生率低于穿刺組的趨勢(shì)。術(shù)后28d隨訪,鎖孔組ADL評(píng)分高于穿刺組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.兩組血清NSE水平及NIHSS評(píng)分在術(shù)后3d達(dá)到峰值,在術(shù)后7d及14天均呈逐漸下降趨勢(shì),但穿刺組下降幅度不如鎖孔組明顯,并且在術(shù)后7d及14d時(shí)顯示出顯著性差異(P0.05),重復(fù)測(cè)量方差分析得出兩組整體間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組患者在術(shù)后3d、7d、14d NIHSS評(píng)分與NSE含量均呈現(xiàn)出明顯的正相關(guān)性(0r1, P0.05),但兩組術(shù)前NIHSS評(píng)分與NSE的水平無顯著性相關(guān)(P0.05)。結(jié)論：1.對(duì)于基底節(jié)區(qū)HICH的患者,當(dāng)術(shù)前血腫量在30-60ml、無腦疝發(fā)生、血腫未破入腦室時(shí)、格拉斯哥昏迷評(píng)分(Glasgow coma scale, GCS)≤12分時(shí),兩種微創(chuàng)手術(shù)治療方式均有效,但是鎖孔組患者血腫清除更徹底、術(shù)后恢復(fù)更快,整體優(yōu)勢(shì)優(yōu)于穿刺組,可首先考慮“鎖孔”開顱血腫清除術(shù)。2.兩組患者血清NSE動(dòng)態(tài)表達(dá)與神經(jīng)功能缺損表現(xiàn)呈明顯正相關(guān),可作為評(píng)價(jià)兩種微創(chuàng)手術(shù)的臨床療效和近期預(yù)后的參考指標(biāo)。
[Abstract]:Objective: to investigate the effect of "keyhole" craniotomy and aspiration drainage in the treatment of hypertensive intracerebral hemorrhage (HICHs) in basal ganglia and its correlation with the level of neuron-specific enolase (NSE) in patients with hypertensive intracerebral hemorrhage (HICHs) in basal ganglia. Methods: the group of keyhole craniotomy, the group of aspiration and drainage and the group of normal health were established. According to the condition of entering the group, 68 patients with HICH in basal ganglia were selected. According to the operation mode, the patients were divided into "keyhole" craniotomy group (hereinafter referred to as keyhole group) and puncture aspiration and drainage group (hereinafter referred to as puncture group), and 20 cases of healthy control group were randomly selected to determine serum NSE level. The operative time, hematoma clearance rate, operative complications, intraoperative blood loss and mortality were compared between the two groups. The changes of serum NSE levels in the keyhole group and puncture group were measured dynamically before operation and at 3 days and 7 days after operation. The neurological impairment was assessed by the National Institutes of Health Stroke scale (NIHSS) at each time point. To analyze the correlation between serum NSE level and NIHSS score, the activities of daily living, ADL was evaluated by Barthel index 28 days after operation to compare the difference of short-term prognosis between the two groups. The result is 1: 1. There were significant differences in operation time, hematoma clearance rate, blood loss during operation and extubation time between the two groups (P 0.05). However, there was no significant difference in operative complications and mortality between the two groups, but the incidence of operative complications in the keyhole group was lower than that in the puncture group. After 28 days follow-up, ADL score in keyhole group was higher than that in puncture group, the difference was statistically significant. The serum NSE level and NIHSS score of the two groups reached the peak on the 3rd day after operation, and gradually decreased on the 7th and 14th days after operation, but the decline rate in the puncture group was not as obvious as that in the keyhole group. There was significant difference between the two groups on the 7th and 14th day after operation (P 0.05). The analysis of variance of repeated measurement showed that the difference between the two groups was statistically significant (P 0.05). There were significant positive correlations between NIHSS score and NSE content in both groups on the 3rd day, 7th day and 14th day after operation, but there was no significant correlation between NIHSS score and NSE level before operation in both groups (P 0.05). Conclusion 1. For patients with basal ganglia HICH, when the preoperative hematoma volume was 30-60 ml, no hernia occurred, and the hematoma did not break into the ventricle, Glasgow coma scale (GCSs) 鈮，

本文編號(hào)：2037549