摘要
目的 探讨局部脑组织氧饱和度(rScO2)监测联合经锁孔入路脑内血肿清除术在脑出血患者治疗中的应用效果.方法 回顾性选取2021年1月至2023年12月延安大学附属医院收治的80例脑出血患者作为研究对象,按照治疗方法不同分为对照组(n=30)、研究1组(n=25)、研究2组(n=25).对照组实施常规开颅手术治疗,研究1组实施经锁孔入路脑内血肿清除术治疗,研究2组在研究1组基础上增加rScO2监测.比较3组患者手术时间、术中出血量、血肿残余量、血肿清除率及住院时间,手术后1、3、7、10 d大脑中动脉血流参数[搏动指数(PI)、平均血流速度(Vm)、收缩期峰值流速(Vs)]变化,手术前及手术后6个月评价3组患者预后情况[格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表(NIHSS)],并比较3组患者术后近远期并发症发生率.结果 研究1组的手术时间、术中出血量分别为(87.95±11.34)min、(45.35±5.12)mL,研究 2 组分别为(88.34±10.57)min、(44.56±5.89)mL,均明显低于对照组[(148.15±32.47)min、(83.82±3.08)mL],差异均有统计学意义(P＜0.05),但研究1组与研究2组的手术时间、术中出血量比较,差异均无统计学意义(P＞0.05);3组患者血肿残余量、血肿清除率比较,差异均无统计学意义(P＞0.05);研究2组住院时间为(16.46±2.68)d,明显短于研究1组[(21.35±2.54)d]与对照组[(23.46±3.14)d],差异有统计学意义(P＜0.05).手术后1 d,3组患者PI、Vm、Vs相关脑血流参数水平比较,差异均无统计学意义(P＞0.05);手术后3、7、10 d,研究2组PI分别为0.62±0.15、0.65±0.16、0.56±0.14,均低于研究1组与对照组,Vm与 Vs 分别为(47.37±5.29)、(51.52±8.73)、(55.37±7.14)cm/s 与(86.25±3.23)、(89.04±2.38)、(90.98±2.36)cm/s,均高于研究1组与对照组,差异均有统计学意义(P＜0.05).手术后6个月,研究1组、研究2组GCS评分均高于对照组,NIHSS评分均低于对照组,差异均有统计学意义(P＜0.05).研究2组与研究1组近期并发症发生率分别为12.00％、12.00％,明显低于对照组(36.67％),差异有统计学意义(P＜0.05),但研究2组与研究1组相比差异无统计学意义(P＞0.05).研究2组远期并发症发生率为28.00％,明显低于研究1组(56.00％)与对照组(60.00％),差异均有统计学意义(P＜0.05).结论 经锁孔入路脑内血肿清除术与常规开颅手术相比可减少术中出血量、手术时间,降低近期并发症,且采取rSc02监测联合经锁孔入路脑内血肿清除术后可进一步改善患者大脑中动脉血流参数,提升患者预后水平,降低远期并发症发生率.
Abstract
Objective To explore the application effect of regional cerebral oxygen saturation(rSc02)monitoring combined with keyhole approach for intracerebral hematoma removal in the treatment of patients with cerebral hemorrhage.Methods A total of 80 patients with cerebral hemorrhage admitted to Yan'an University Affiliated Hospital from January 2021 to December 2023 were retrospectively selected as the research ob-jects.According to different treatment methods,they were divided into the control group(n=30),the study group 1(n=25)and the study group 2(n=25).The control group received routine craniotomy treatment,while the study group 1 received treatment for intracerebral hematoma removal through a keyhole approach.The study group 2 received additional rScO2 monitoring in addition to the study group 1.The operation time,intraoperative blood loss,residual hematoma volume,hematoma clearance rate,and hospital stay among three groups of patients,as well as the changes in cerebral artery blood flow parameters[pulsatility index(P1),mean blood flow velocity(Vm),peak systolic velocity(Vs)]at 1 day,3 days,7 days,and 10 days after operation were compared.The prognosis[Glasgow coma scale(GCS),National Institutes of Health Stroke Scale(NIHSS)]of the three groups was evaluated before and 6 months after operation,and the incidence of short-term and long-term complications among the three groups of patients were compared.Results The operation time and intraoperative blood loss of the study group 1 were(87.95±11.34)min and(45.35±5.12)mL,respectively,and those of the study group 2 were(88.34±10.57)min and(44.56±5.89)mL,respec-tively,which were significantly lower than those of the control group[(148.15±32.47)min,(83.82±3.08)mL],and the differences were statistically significant(P＜0.05).The hospital stay of the study group 2 was(16.46±2.68)d,which was significantly shorter than that of the study group 1[(21.35±2.54)d]and the control group[(23.46±3.14)d],and the difference was statistically significant(P＜0.05).There were no statistically significant differences in the levels of PI,Vm and Vs related cerebral blood flow parameters among the three groups at 1 day after operation(P＞0.05).At 3,7 and 10 days after operation,the PI of the study group 2 were 0.62±0.15,0.65±0.16 and 0.56±0.14,respectively,which were lower than those of the study group 1 and the control group.The Vm and Vs were(47.37±5.29),(51.52±8.73),(55.37±7.14)cm/s and(86.25±3.23),(89.04±2.38),(90.98±2.36)cm/s,respectively,which were higher than those of the study group 1 and the control group,and the differences were statistically significant(P＜0.05).At 6 months after operation,the GCS scores of the study group 1 and the study group 2 were higher than those of the control group,and the NIHSS scores were lower than those of the control group,the differences were statistically significant(P＜0.05).The recent complication rate of the study group 2 and study group 1 were 12.00％and 12.00％,respectively,which were significantly lower than the control group(36.67％),and the difference were statistically signif-icant(P＜0.05),but there was no statistically significant difference between the study group 2 and the study group 1(P＞0.05).The inci-dence of long-term complications in the study group 2 was 28.00％,which was significantly lower than that in the study group 1(56.00％)and the control group(60.00％),the differences were statistically significant(P＜0.05).Conclusion Compared with conventional craniotomy,the keyhole approach for intracerebral hematoma removal can reduce intraoperative bleeding and surgical time in patients,reduce the incidence of recent complications,and adopt rScO2 monitoring combined with keyhole approach for intracerebral hematoma removal can further improve the blood flow parameters of the middle cerebral artery in patients,improve their prognosis,and reduce the incidence of long-term complications.
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