开颅与钻孔引流术治疗高血压性脑出血后颅内压变化及其与病人术后认知功能障碍的关联性研究

目的:探讨开颅与钻孔引流术治疗高血压性脑出血后颅内压变化情况及其与病人术后认知功能障碍的关联性.方法:选择高血压性脑出血病人106例,采用随机数字表法分为开颅组(53例)和钻孔组(53例),分别采用传统的开颅引流术和微创钻孔引流术进行治疗,比较2组病人术后1、12、24、72 h和1周颅内压和术后神经功能缺损及认知功能恢复情况.结果:术后1、12、24、72 h和1周钻孔组病人的颅内压均明显高于开颅组(P<0.01);术后6个月,钻孔组病人的美国国立卫生院神经功能缺损评分低于开颅组(P<0.01),2组病人美国国立卫生院神经功能缺损评分均明显低于术前(P<0.01);术后1个月,钻孔组神经元特异性烯醇化酶和脑源性神经营养因子水平均明显低于开颅组(P<0.01),2组病人神经元特异性烯醇化酶水平明显低于术后3 d,脑源性神经营养因子水平明显高于术后3 d(P<0.01);术后6个月,2组病人认知功能障碍程度较术前均有所改善(P<0.01);钻孔组简易智能精神状态量表评分分布情况优于开颅组(P<0.01),钻孔组认知功能障碍率低于开颅组(P<0.05).结论:在治疗高血压性脑出血中,开颅引流术在降低颅内压方面具有优势,而在改善病人的神经功能及认知功能方面,钻孔引流术更具优势.

The intracranial pressure change in hypertensive cerebral hemorrhage patients treated with drilling and craniotomy drainage,and its correlation with postoperative cognitive dysfunction

Objective:To investigate the intracranial pressure changes in hypertensive cerebral hemorrhage patients treated with drilling and craniotomy drainage,and its correlation with postoperative cognitive dysfunction. Methods:One hundred and six patients with hypertensive cerebral hemorrhage were randomly divided into the craniotomy group and drilling group using the random number table method(53 cases each group). The craniotomy group and drilling group were treated with traditional craniotomy drainage and minimally invasive drilling drainage,respectively. The postoperative neurologic deficit and cognitive function recovery after 1 h,12 h,24 h,72 h and 1 w of operation between two groups were compared. Results:The intracranial pressure after 1 h,12 h,24 h,72 h and 1 w of operation in drilling group were significantly higher than those in craniotomy group(P <0. 01). After 6 months of operation,the NIHSS score in drilling group was lower than that in craniotomy group(P < 0. 01),and the NIHSS scores of two groups were significantly lower than that before operation(P <0. 01). After 1 month of operation,the levels of NSE and BDNF in drilling group were lower than those in craniotomy group(P < 0. 01),the levels of NSE and BDNF in two groups after 1 month of operation were significantly lower and higher than those after 3d of operation,respectively(P < 0. 01). After 6 months of operation,the cognitive dysfunction in two groups were improved compared before operation(P <0. 01). The distribution of MMSE score in drilling group was better than that in craniotomy group(P <0. 01),The rate of cognitive impairment in drilling group was significantly lower than that in craniotomy group ( P < 0. 05). Conclusions: In the treatment of hypertensive cerebral hemorrhage, the craniotomy drainage has advantage in reducing intracranial pressure,and the drilling drainage has advantage in improving nerve function and cognitive function.