微创颅内血肿引流术治疗老年高血压脑出血患者临床疗效观察

目的探讨微创颅内血肿清除术改善老年高血压脑出血患者脑神经功能缺损的机制及效果。 方法选取自2013年5月至2015年4月收治在衡水市第四人民医院神经外科的老年高血压脑出血患者116例（均为幕上出血<35 ml），入院后向患者家属提出微创颅内血肿清除术和常规保守治疗两种治疗方案，详细说明两种治疗方法的利弊后，根据其选择意见分为研究组和对照组各58例。两组患者年龄、性别、颅内血肿量及部位、偏瘫人数、格拉斯哥评分等资料比较差异无统计学意义（P>0.05），研究组行微创颅内血肿清除术，对照组行常规保守治疗，比较两组炎症因子、血肿及周围水肿量和国立卫生研究院卒中量表（NIHSS）评分结果。 结果两组患者治疗前血清白细胞介素-6（IL-6）分别为（11.3±2.8）ng/L、（11.8±3.2）ng/L；肿瘤坏死因子-α（TNF-α）水平分别为（42.8±5.3）μg/L、（43.2±4.6）μg/L，经比较差异无统计学意义（P>0.05）；治疗后研究组患者IL-6和TNF-α水平为（15.4±3.2）ng/L、（44.2±4.3）μg/L，显著低于对照组水平（28.2±4.2）ng/L、（50.6±4.8）μg/L，数据间比较差异具有统计学意义（P<0.05）。两组患者治疗前血肿量和周围水肿量分别为（11.3±2.8）ml、（11.8±3.2）ml、（10.2±4.8）ml、（10.3±5.2）ml，经比较差异无统计学意义（P>0.05）；治疗后研究组患者血肿量和周围水肿量为（8.8±4.8）ml、（6.2±3.6）ml，显著低于对照组水平（18.6±5.3）ml、（18.8±7.2）ml，数据间比较差异具有统计学意义（P<0.05）。两组患者治疗前NIHSS评分为（12.8±4.2）分、（12.6±4.3）分，经比较差异无统计学意义（P>0.05）；治疗后研究组NIHSS评分（4.6±2.2）分，显著低于对照组评分（6.8±1.8）分，数据间比较差异具有统计学意义（P<0.05）。 结论微创颅内血肿清除术可快速清除或减轻颅内血肿占位，降低颅内压，并通过减轻脑组织炎性反应机制改善水肿，促进神经功能改善，提高对老年高血压脑出血的疗效。

Clinical effect of minimally invasive intracranial hematoma drainage on hypertensive cerebral hemorrhage in the aged people

ObjectiveTo discuss the effect and the mechanism of minimally invasive intracranial hematoma drainage on hypertensive cerebral hemorrhage in the aged people. MethodsOne hundred and sixteen cases of aged patients with hypertensive cerebral hemorrhage, all are supratentorial hematomas with volume less than 35 ml, were selected in this study. The patients’ relatives were given detail information of advantages and disadvantages of the two different treatment methods. According to their opinion, patients were divided into two groups, the research group and the control group, each group has fifty eight patients. There is no significant different in the age, gender, the location and the volume of hematoma, the onset of hemiplegia, and the GCS between the two groups. Patients in research group underwent minimally invasive intracranial hematoma drainage, while patients in control group underwent conservative treatment. The changes of serum tumor necrosis factor-α(TNF-α), interleukin-6(IL-6),hematoma volume, surrounding edema, and national institutes of health stroke scale(NIHSS) of the two groups were observed and compared. ResultsBefore treatment, the IL-6 of the two groups were (11.3±2.8) ng/L and (11.8±3.2) ng/L respectively, the TNF-α were (42.8±5.3) μg/L and (43.2±4.6) μg/L respectively. There were no significant difference between the two group(P>0.05). After treatment, the IL-6 (15.4±3.2) ng/L and the TNF-α(44.2±4.3) μg/L level of research group were significantly lower than that of control group (28.2±4.2) ng/L and (50.6±4.8) μg/L (P<0.05). Before treatment, the hematoma volume of the two group were (11.3±2.8) ml and (11.8±3.2) ml respectively, the surrounding edema volume were (10.2±4.8) ml and (10.3±5.2) ml respectively. There were no significant difference between the two group(P>0.05). After treatment, the hematoma volume (8.8±4.8) ml and the edema volume (6.2±3.6) ml of research group were significantly lower than that of control group (18.6±5.3) ml and (18.8±7.2) ml (P<0.05). Before treatment, the NIHSS of the two groups were (12.8±4.2) and (12.6±4.3) respectively, compared with no significant difference (P<0.05). After treatment, the NIHSS of research group (4.6±2.2) were significantly lower than that of control group (6.8±1.1) (P<0.05). ConclusionMinimally invasive intracranial hematoma drainage can rapidly reduce the mass effect of the hematoma, lower the intracranial pressure, alleviate cerebral edema via reduce inflammatory reaction of brain tissue, improve the function of central nervous system, thus it can improve the curative effect of hypertensive cerebral hemorrhage in the aged people.