软通道血肿穿刺引流术治疗高血压脑出血患者的效果

doi:10.3760/cma.j.issn.1007-1245.2024.05.021

摘要/Abstract

摘要：

目的　探讨软通道血肿穿刺引流术对高血压脑出血（HICH）患者微小核糖核酸-21（miR-21）、微小核糖核酸-124（miR-124）、可溶性髓系细胞触发受体-1（sTREM-1）、降钙素原（PCT）及神经功能的影响。方法　本研究为随机对照试验，选取2020年2月至2023年2月安康市中心医院接受治疗的61例HICH患者作为研究对象，采用随机数字表法分为A组（31例）和B组（30例）。A组男19例、女12例，年龄（58.98±10.65）岁，出血部位：丘脑3例、小脑2例、基底节区23例、顶叶1例、额叶1例、颞叶1例。B组男17例、女例13例，年龄（59.20±10.71）岁，出血部位：丘脑3例、小脑3例、基底节区20例、顶叶1例、额叶2例、颞叶1例。A组给予神经内镜颅内血肿清除术（NEIHE），B组给予软通道血肿穿刺引流术（SCPD），术后均随访6个月。对比两组患者手术相关指标，术后1个月治疗效果，术前、术后7 d、1个月神经功能［美国国立卫生研究院卒中量表（NIHSS）评估］，术前、术后1个月的miR-21、miR-124、sTREM-1、PCT水平及随访期间并发症情况。统计学方法采用t检验、χ²检验。结果　B组术中出血量、住院费用及72 h血肿清除率均低于A组［（46.65±42.43）ml比（71.67±44.76）ml、（65 543.54±23 521.06）元比（96 574.76±50 234.54）元、（73.65±12.87）%比（88.09±17.65）%］，手术时间短于A组［（0.65±0.32）h比（2.03±0.41）h］，重症监护病房（ICU）住院时间长于A组［（9.65±5.54）d比（2.65±1.76）d］，差异均有统计学意义（t=2.239、3.073、3.641、14.622、6.696，均P<0.05）。术后1个月，B组总有效率为93.33%（28/30），高于A组的70.97%（22/31），差异有统计学意义（χ²=5.160，P=0.023）。术前，两组患者神经功能比较，差异无统计学意义（P>0.05）；术后7 d及术后1个月，B组神经功能评分均低于A组［（16.65±3.65）分比（19.87±3.87）分、（6.54±0.65）分比（13.76±1.76）分］，差异均有统计学意义（t=3.341、21.114，均P<0.05）。术前，两组患者miR-21、miR-124、sTREM-1、PCT水平比较，差异均无统计学意义（均P>0.05）；术后1个月，B组血清miR-21水平高于A组［（3.02±0.45）比（2.37±0.41）］，miR-124、sTREM-1、PCT水平均低于A组［（5.43±0.45）比（6.98±0.67）、（6.87±0.23）ng/L比（16.87±1.65）ng/L、（2.76±0.18）μg/L比（5.87±0.79）μg/L］，差异均有统计学意义（t=5.901、10.571、32.879、21.035，均P<0.05）。B组随访期间并发症发生率为46.67%（14/30），与A组25.81%（8/31）比较，差异无统计学意义（χ²=2.877，P=0.090）。结论　在HICH治疗中，NEIHE血肿清除效果较好，有助于缩短ICU住院时间，但SCPD可减少术中出血量及住院费用，缩短手术时间，改善神经功能，调节患者miR-21、miR-124、sTREM-1、PCT表达水平，提高治疗效果。

关键词:

高血压脑出血, 神经内镜颅内血肿清除术, 软通道血肿穿刺引流术, 神经功能

Abstract:

Objective　To explore the effects of soft channel hematoma puncture and drainage on microRNA-21 (miR-21), microRNA-124 (miR-124), soluble myeloid cell trigger receptor-1 (sTREM-1), procalcitonin (PCT), and neurological function in patients with hypertensive intracerebral hemorrhage (HICH). Methods　Sixty-one patients with HICH who were treated at Ankang Central Hospital from February 2020 to February 2023 were selected for the randomized controlled trial, and were divided into group A (31 cases) and group B (30 cases) by the random number table method. There were 19 males and 12 females in group A; they were (58.98±10.65) years old; 3 cases had hemorrhage on thalamus, 2 cases on cerebellum, 23 cases on basal ganglia area, 1 case on parietal lobe, 1 case on frontal lobe, and 1 case on temporal lobe. There were 17 males and 13 females in group B; they were (59.20±10.71) years old; 3 cases had hemorrhage on thalamus, 3 cases on cerebellum, 20 cases on basal ganglia area, 1 case on parietal lobe, 2 case on frontal lobe, and 1 case on temporal lobe. Group A took the endoscopic intracranial hematoma removal surgery (NEIHE), while group B soft channel hematoma puncture and drainage surgery. All the patients were followed up for 6 months after the surgery. The surgery related indicators, including treatment efficacy 1 month after the surgery, neurological function [National Institute of Health Stroke Scale (NIHSS)] before and 7 d and 1 month after the surgery, the levels of miR-21, miR-124, sTREM-1, and PCT before and 1 month after the surgery, and complications during follow-up were compared between the two groups. t and χ² tests were applied. Results　The intraoperative bleeding volume, hospitalization cost, and 72 h hematoma clearance rate in group B were lower than those in group A [(46.65±42.43) ml vs. (71.67±44.76) ml, (65 543.54±23 521.06) yuan vs. (96 574.76±50 234.54) yuan, and (73.65±12.87)% vs. (88.09±17.65)%]; the operation time in group B was shorter than that in group A [(0.65±0.32) h vs. (2.03±0.41) h]; the time of hospitalization in the intensive care unit (ICU) in group B was longer than that in group A [(9.65±5.54) d vs. (2.65±1.76) d]; there were statistical differences (t=2.239, 3.073, 3.641, 14.622, and 6.696; all P<0.05). One month after the surgery, the total effective rate in group B was higher than that in group A [93.33% (28/30) vs. 70.97% (22/31)], with a statistical difference (χ²=5.160; P=0.023). Before the surgery, there was no statistical difference in the neurological function between the two groups (P>0.05). Seven days and 1 month after the surgery, the scores of neurological function in group B were lower than those in group A [(16.65±3.65) vs. (19.87±3.87) and (6.54±0.65) vs. (13.76±1.76)], with statistical differences (t=3.341 and 21.114; both P<0.05). Before the surgery, there were no statistical differences in the levels of miR-21, miR-124, sTREM-1, and PCT between the two groups (all P>0.05). One month after the surgery, the levels of miR-21, miR-124, sTREM-1, and PCT in group B were better than those in group A [(3.02±0.45) vs. (2.37±0.41), (5.43±0.45) vs. (6.98±0.67), (6.87±0.23) ng/L vs. (16.87±1.65) ng/L, and (2.76±0.18) μg/L vs. (5.87±0.79) μg/L], with statistical differences (t=5.901, 10.571, 32.879, and 21.035; all P<0.05). There was no statistical difference in the incidence of complications during follow up between group B and group A [46.67% (14/30) vs. 25.81% (8/31); χ²=2.877; P=0.090]. Conclusions　In the treatment of patients with HICH, NEIHE is more effective in hematoma removal, and helps shorten ICU hospitalization. However, soft channel hematoma puncture and drainage can significantly shorten operation time, reduce intraoperative bleeding and hospitalization cost, improve their neurological function and treatment efficacy, and regulate the expression levels of miR-21, miR-124, sTREM-1, and PCT.

Key words:

Hypertensive intracerebral hemorrhage, Neuroendoscopic removal of intracranial hematoma, Soft channel hematoma puncture and drainage surgery, Neurological function

王坤张淳化罗长稳李海.

软通道血肿穿刺引流术治疗高血压脑出血患者的效果 [J]. 国际医药卫生导报, 2024, 30(5): 808-813.

Wang Kun, Zhang Chunhua, Luo Changwen, Li Hai.

Soft channel hematoma puncture and drainage for patients with hypertensive intracerebral hemorrhage [J]. International Medicine and Health Guidance News, 2024, 30(5): 808-813.

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