不同微创术对脑出血血肿周围缺血再灌注损伤的临床研究

目的探讨锥颅血肿抽吸术及抽吸引流术后对脑出血患者血肿周围缺血区的再灌注损伤。方法将117例高血压脑出血患者随机分为锥颅血肿抽吸组60例和抽吸引流组57例，分别于术后3d及1、2、3周通过CT动态观察其血肿周围缺血半暗区的变化，以此来评定其再灌注损伤的程度。结果血肿抽吸组术后血肿明显缩小，但血肿周围缺血半暗区术后3d明显增大，1周迭高峰，2周开始稳定，3周明显下降；抽吸引流组术后血肿及血肿周围缺血半暗区逐渐缩小；两组比较差异有显著性。结论锥颅血肿抽吸术后血肿周围出现明显缺血再灌注损伤，原因可能是血肿腔减压后血肿周围血供改善，血肿腔内血管活性物质的吸收引发炎症和免疫反应所致；抽吸引流术可较快而持续引流出大量水肿液及血肿腔内血管活性物质，因而出现血肿周围缺血再灌注损伤不明显，疗效肯定。

Perihematoma ischemia reperfusion damage of various minimally invasive surgeries in cerebral hemorrhage patients

Objective To explore the reperfusion damage of peri hematoma after pumped craniopuncture or pumped and drained craniopuncture in cerebral hemorrhage patients.Methods 117 cases of hypertension cerebral hemorrhage were randomly divided into two groups: the pumped group (n=60) and the pumped and drained group(n=57).The ischemic penumbra was observed dynamically by CT at 3 day,1,2 and 3 week after operation for the assessment of reperfusion damage degree.Results In pumped group,the brain edema decreased apparently after operation,but the ischemic penumbra was increased 3 days after operation and peaked at 1 week,began to remain stable at 2 week and decrease significantly at 3 week after surgery.On the contrary,the ischemic penumbra and the brain edema decreased gradually in pumped and drained group,with significant difference between the groups.Conclusion Ischemic-reperfusion damage after pumped craniopuncture may be caused by the improved blood supply around hematoma after decompression of hematoma cavity and the inflammatory and immunologic response caused by the absorption of blood vessel active matter from hematomal cavity.Pumped and drained craniopuncture can remove a lot of hematoma-fluid and active matter from hematomal cavity and lessen the perihematomal ischemic reperfusion damage,with assured therapeutic effects.