脑出血患者微创钻颅血肿抽吸液化引流术后血清炎性因子水平的变化及其临床意义

目的 探讨经微创钻颅置管血肿抽吸液化引流术治疗脑出血后患者的血清炎性因子水平变化及神经功能恢复情况.方法 2006年2月至2008年4月我院经额部入路锥颅置管血肿抽吸液化引流术治疗高血压脑出血患者81例(观察组),并与同期采用保守治疗的80例患者(对照组)进行比较.各组出血量均为15～30 ml,观察组于入院6～24 h采用额部入路进行穿刺.对照组采用传统保守治疗.于手术后1、7、14、30 d分别进行神经功能评分、血清白细胞介素-6、超敏C-反应蛋白、肿瘤坏死因子-α的测定,并进行比较观察.结果术后7 d观察组与对照组神经功能评分分别为27.47±6.21及39.28±8.32,观察组明显优于对照组(t=8.80,P＜0.05),且炎性因子水平低于对照组(P均＜0.01);观察组14 d(19.14±5.21,31.16±7.99)及30 d(15.33±4.47,25.33±5.55)神经功能评分均优于对照组(t值分别为10.70、15.83,P均＜0.05),14 d炎性因子观察组明显低于对照组(P＜0.05或P＜0.01),30 d 2组炎性因子水平差异无统计学意义(P均＞0.05).结论 微创钻颅置管血肿抽吸液化引流术治疗脑出血,不但可以明显改善神经功能,亦可于出血早期明显减轻炎性因子的产生及释放,有利于保护健康脑组织及全身其他脏器,明显有利于脑出血的恢复及痊愈.

Change of serum inflammatory factors in cerebral hemorrhage patients after haematoma fluidify drainage operation

Objective To study the change of inflammatory factors in cerebral hemorrhage patients after haematoma fluidify drainage operation and the recovery of neural function.Methods In the observe group,eightyone cases of hypertensive cerebral hemorrhage were treated by haematoma fluidify drainage operation through bore skull and tube placed through the entrance of rear forehead,eighty patients underwent conservative treatment at the same period were taken as controls.The bleeding quantities ranged from 15 to 30 ml in both groups.The observe group underwent operation within 6-24 hours.The neural-functional grade was observed and serum IL-6 ,TNF-a,CRP after the operation of 1,7,14,and 30 days were measured.Results On the 7th day after operation,the neural functional grade was 27.47 ±6.21 in the observed group,which was significantly lower than that of the control group (39.28 ±8.32) (P＜0.05).On the 14th and 30th day after operation,the neural functional grade in the observed group ( 19.14 ± 5.21,15.33 ± 4.47,respectively) were significantly lower than those of the control group (31.16 ±7.99,25.33 ± 5.55,respectively ) ( P ＜ 0.05 ) .The level of inflammation factor in the observe group was significantly lower than that in the control group on the 7th and 14th day after operation(P ＜0.01 and P ＜0.05,respectively) ,whereas on the 30th day there was no significant difference between the two groups(P ＞ 0.05).Conclusions The minimally invasive haematoma fluidify drainage operation can not only improve neural function,but also can reduce the product and release of inflammatory factors in the early stage of cerebral hemorrhage.It is helpful to protect the healthy cerebral tissue and other organs,therefore remarkably beneficial to the recovery and cure of cerebral hemorrhage.