摘要
目的 探讨微创颅内血肿清除术对高血压脑出血患者血管活性物质、TCD参数及血清可溶性CD40配体(sCD40L)、基质金属蛋白酶-9(MMP-9)、高迁移率族蛋白B1(HMGB-1)水平的影响.方法 选取2022年1月-2023年6月于荣县人民医院收治的60例高血压脑出血患者为研究对象,根据治疗方式的不同将患者分为对照组(n=30)和研究组(n=30),对照组患者行小骨窗颅内血肿清除术治疗,研究组患者行微创颅内血肿清除术治疗.比较两组术前1 d,术后1、7、21 d血管活性物质[内皮素(ET)、血管升压素(AVP)]、TCD参数[收缩期峰血流速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)、搏动指数(RI)]及血清sCD40L、MMP-9、HMGB-1水平.结果 术后 1、7及21 d,研究组和对照组血清ET(F=77.469、25.806,P均＜0.001)、AVP(F=252.399、68.781,P均＜0.001)、sCD40L(F=121.190、70.891,P 均＜0.001)、MMP-9(F=140.814、265.522,P 均＜0.001)、HMGB-1(F=224.247、27.162,P均＜0.001)水平较术前降低,且研究组以上指标水平低于对照组(P均＜0.05),差异均有统计学意义.术后 1、7 及 21 d,研究组和对照组 Vs(F=5.314、5.535,P均＜0.001)、Vd(F=15.620、15.357,P均＜0.001)、Vm(F=8.053、8.640,P均＜0.001)较术前明显升高,RI较术前明显降低(F=30.872、29.244,P均＜0.001),差异均有统计学意义,但两组上述指标比较差异均无统计学意义(P均＞0.05).结论 采用微创颅内血肿清除术治疗高血压脑出血患者具有较好的疗效,能够恢复患者血管舒缩功能,降低颅内压,减轻炎性反应,改善预后.
Abstract
Objective To investigate the effects of minimally invasive intracranial hematoma removal surgery on vasoactive substances,TCD parameters,and serum levels of soluble CD40 ligand(sCD40L),matrix metalloproteinase-9(MMP-9),and high mobility group protein B1(HMGB-1)in patients with hypertensive intracerebral hemorrhage.Methods Sixty patients with hypertensive intracerebral hemorrhage were collected as the study subjects and separated into control group(n=30)and study group(n=30)according to different treatment methods.The control group received small bone window intracranial hematoma removal surgery,while the study group received minimally invasive intracranial hematoma removal surgery.The vasoactive substances[endothelin(ET),vasopressin(AVP)],TCD parameters[peak systolic blood flow velocity(Vs),end diastolic blood flow velocity(Vd),mean blood flow velocity(Vm),pulsatile index(RI)]and serum sCD40L,MMP-9,and HMGB-1 levels were compared between the two groups on the 1st day before surgery,1st day,7th day,and 21st day after surgery.Results After operation 1,7 and 21 days,the serum levels of ET(F=77.469,25.806;all P＜0.001),AVP(F=252.399,68.781;allP＜0.001),sCD40L(F=121.190,70.891;all P＜0.001),MMP-9(F=140.814,265.522;all P＜0.001),HMGB-1(F=224.247,27.162;all P＜0.001)in the study group were lower than those in the control group,and the differences were statistically.Compared with preoperative surgery,1,7 and 21 d Vs(F=5.314,5.535;all P＜0.001),Vd(F=15.620,15.357;all P＜0.001),Vm(F=8.053,8.640;all P＜0.001)increased significantly in study group and control group;RI(F=30.872,29.244;all P＜0.001)significantly decreased in study group and control group,but the two groups were not statistically significant(P＞0.05).Conclusion Minimally invasive intracranial hematoma removal surgery had a good therapeutic effect on patients with hypertensive intracerebral hemorrhage,which could restore the patient's vasomotor function,reduce intracranial pressure,alleviate inflammatory reactions,and improve prognosis.
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