锥颅血肿引流术微创治疗老年高血压脑出血的疗效及对血清IL—6、hs—CRP和NSE水平的影响

莫泉　梁才干　赖为峰

[摘要] 目的 探析老年高血压脑出血患者进行锥颅血肿引流术治疗的临床效果及对患者血清IL-6、hs-CRP及NSE水平的影响研究。方法 入选我院2013年6月～2014年5月老年高血压脑出血患者86例，根据随机数字表法分为对照组和研究组，每组43例，研究组进行锥颅血肿引流术疗法，对照组进行开颅手术疗法，应用Glasgow昏迷量表评估两组治疗前、治疗后1周的意识状态、手术时间、术中出血量、住院时间等临床指标；比较两组治疗后1周、治疗后1个月的NSE、超敏C反应蛋白（hs-CRP）、血清白介素6（IL-6）、血肿残余体积、NIHSS评分等临床指标；比较两组治疗后的并发症发生情况。结果 研究组治疗1周后的Glasgow昏迷量表评分、手术时间、术中出血量、住院时间等临床指标显著优于对照组，差异有统计学意义（P<0.05）；研究组治疗后1周、治疗后1个月随访检测的NSE、超敏C反应蛋白（hs-CRP）、血清白介素6（IL-6）、血肿残余体积、NIHSS评分等临床指标显著优于对照组，差异有统计学意义（P<0.05）；研究组治疗后发生应激性溃疡、脑积液、脑疝、再出血、死亡等并发症情况显著低于对照组，差异有统计学意义（P<0.05）。结论 老年高血压脑出血进行锥颅血肿引流术疗法，高度微创，促进病情迅速康复，降低并发症，改善NSE水平及血清炎症，临床效果确切，值得临床推广。

[关键词] NSE；血清炎症；高血压脑出血；锥颅血肿引流术

[中图分类号] R651.1 [文献标识码] B [文章编号] 2095-0616（2015）24-185-04

[Abstract] Objective To explore curative effect of dexamethasone injection into the cavity of hematoma in minimally invasive treatment of senile hypertensive brain hemorrhage and its effect on serum IL-6， hs-CRP and NSE levels. Methods 86 patients with senile hypertensive brain hemorrhage who were admitted to our hospital from June 2103 to May 2014 were selected and they were allocated to the control group and the study group according to random number table， with 43 in each. The study group was received treatment of dexamethasone injection into the cavity of hematoma while the control group was received digging skull operation. Clinical indexes including conscious state， operation time， intraoperative blood loss， hospitalization time and so on one week before and after treatment of two groups were assessed by Glasgow Coma Scale. Clinical indexes including NSE， high-sensitivity C-reactive protein （hs-CRP）， serum interleukin 6 （IL-6）， residual volume of hematoma， NIHSS scoring and so on of one week and one month after treatment of two groups were compared. In addition， incidences of complications after treatment of two groups were compared. Results Scores of Glasgow Coma Scale and clinical indexes including operation time， intraoperative blood loss， hospitalization time and so on of 1 week after treatment of the study group were significantly better than those of the control group. The difference was statistically significant （P<0.05）. Clinical indexes including NSE， high-sensitivity C-reactive protein （hs-CRP）， serum interleukin 6 （IL-6）， residual volume of hematoma， NIHSS scoring and so on of one week and one month after treatment of the study group were significantly better than those of the control group. The difference was statistically significant （P<0.05）. Incidence of complications including stress ulcer， brain effusion， cerebral hernia， recurrent hemorrhage， death and so on of the study group were significantly lower than that of the control group. The difference was statistically significant （P<0.05）. Conclusion Dexamethasone injection into the cavity of hematoma in treatment of senile hypertensive brain hemorrhage is highly minimally invasive. It can promote rehabilitation， reduce complications and improve NSE level and serum inflammation. And it has accurate clinical curative effect， worthy of clinical promotion.endprint

[Key words] NSE； Serum inflammation； Hypertensive brain hemorrhage； Dexamethasone injection into the cavity of hematoma

高血压性脑出血是脑血管病中病死率和致残率都很高的一种疾患，男性发病率稍高，多见于50～60岁老年人[1]。高血压患者约有1/3概率会发生脑出血，而脑出血患者有高血压病史者约占95%左右。有文献显示，老年高血压脑出血进行锥颅血肿引流术疗法，高度微创，促进病情迅速康复，降低并发症，改善NSE水平及血清炎症，临床效果确切[2]。探析高血压脑出血高龄患者的最佳治疗方式具有重要的临床价值，故我院2013年6月～2014年5月对高血压脑出血高龄患者进行锥颅血肿引流术微创疗法，效果满意，现报道如下。

1 资料与方法

1.1 一般资料