摘要
目的:分析亚低温联合脑室穿刺引流对老年性高分级动脉瘤性蛛网膜下腔出血患者脑血管状态的影响。方法:选取2019年4月至2020年5月在湖南省脑科医院（湖南省第二人民医院）就诊的老年性高分级动脉瘤性蛛网膜下腔出血患者162例，根据随机数字分配法分为脑室穿刺引流治疗组和联合治疗组，各81例。脑室穿刺引流治疗组给予脑室穿刺引流治疗，联合治疗组在脑室穿刺引流治疗组的治疗基础上增加亚低温治疗方法。分别于治疗前、术后7 d、术后14 d采用彩色经颅多普勒血流分析仪对动脉血流速度、颅内压进行检测，采用酶联免疫法检测血浆内皮素、降钙素水平，应用脑室内出血Graeb评分评估脑室内出血状况，应用格拉斯哥预后评分（GOS）评估预后情况。采用独立样本t检验比较上述资料组间差异，采用重复测量方差分析比较治疗前后的差异；采用χ2检验比较组间临床疗效的差异。结果:脑室穿刺引流治疗组患者术后7 d、14 d的动脉血流速度[（110.57±11.46）mIU/ml、（80.48±6.35）mIU/ml]、颅内压[（83.91±12.96）mmH2O、（67.47±7.28）mmH2O]、内皮素水平[（25.87±6.58）pg/ml、（15.85±1.59）pg/ml]、Graeb评分[（6.21±0.26）分、（4.12±0.24）分]低于治疗前[（170.25±23.55）mIU/ml、（118.64±14.86）mmH2O、（30.27±6.24）pg/ml、（8.24±0.13）分]；降钙素水平[（54.63±5.23）pg/ml、（64.64±5.23）pg/ml]、GOS[（3.56±0.53）分、（5.67±0.56）分]高于治疗前[（34.94±3.53）pg/ml、（1.27±0.87）分]，差异具有统计学意义（F=20.510、15.850、4.367、62.850、28.080、20.230，P均＜0.001）。联合治疗组患者术后7 d、14 d的动脉血流速度[（98.73±15.20）mIU/ml、（68.74±9.21）mIU/ml]、颅内压[（74.53±13.07）mmH2O、（60.28±6.57）mmH2O]、内皮素水平[（20.47±8.73）pg/ml、（12.48±1.74）pg/ml]、Graeb评分[（6.02±0.24）分、（4.03±0.21）分]低于治疗前[（170.31±18.57）mIU/ml、（118.57±14.93）mmH2O、（30.31±4.86）pg/ml、（8.26±0.57）分]，降钙素水平[（59.56±2.58）pg/ml、（74.57±5.49）pg/ml]、GOS[（4.57±0.21）分、（6.24±0.23）分]高于治疗前[（34.98±4.86）pg/ml、（1.31±0.83）分]，差异具有统计学意义（F=26.850、20.110、8.863、32.600、40.200、23.300，P均＜0.001）。术后7 d、14 d联合治疗组动脉血流速度、颅内压、脑积血完全清除时间[（15.85±1.59）d vs（18.95±4.58）d]、内皮素水平、Graeb评分低于脑室穿刺引流治疗组，差异具有统计学意义（t=5.598、9.445，4.587、6.599，5.729，4.448、12.870，4.833、2.540，P＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001、=0.012）；降钙素水平、GOS高于脑室穿刺引流治疗组，差异具有统计学意义（t=7.608、11.790，15.940、8.474，P均＜0.001）。联合治疗组临床疗效总有效率（92.59%）高于脑室穿刺引流治疗组（67.90%），差异具有统计学意义（χ2=15.570，P＜0.001）。结论:亚低温联合脑室穿刺引流对老年性高分级动脉瘤性蛛网膜下腔出血的治疗效果较好，可改善患者脑血管状态和内皮素、降钙素水平，减少患者脑室内出血，促进患者恢复，效果显著。
Abstract
Objective:Analyze the effect of mild hypothermia combined with ventricular puncture and drainage on cerebral vascular status in elderly patients with severe aneurysmal subarachnoid hemorrhage.Methods:162 elderly patients with high-grade aneurysmal subarachnoid hemorrhage who visited Hunan Provincial Brain Hospital (the Second People's Hospital of Hunan Province) from April 2019 to May 2020 were selected. according to the random number allocation method is divided into ventricular puncture drainage and treatment group and combined treatment group, each 81 cases, cerebral ventricular puncture drainage treatment group, combined treatment group in the ventricular puncture drainage treatment group on the basis of subhypothermia treatment method. At pre-treatment, 7 days and 14 days after surgery, the arterial blood flow velocity and intracranial pressure level were measured by color transcranial Doppler flow analyzer. The plasma endothelin and calcitonin levels were measured by enzyme-linked immunization method. The intraventricular hemorrhage Graeb score was used to evaluate the prognosis of intraventricular hemorrhage and Glasgow outcome score (GOS). The above experimental data were described, independent sample t-test, comparison data before and after treatment for repeated measurement analysis of variance, F-value test; count data were expressed by frequency and percentage, and χ2 test for comparison between groups.Results:Arterial blood flow velocity [(110.57±11.46)mIU/ml, (80.48±6.35)mIU/ml], intracranial pressure [(83.91±12.96) mmH2O, (67.47±7.28)mmH2O], endothelin [(25.87±6.58)pg/ml, (15.85±1.59)pg/ml], Graeb score [6.21±0.26, 4.12±0.24] of ventricular puncture drainage and treatment group 7 days, 14 days after surgery were lower than pre-treatment [(170.25±23.55)mIU/ml, (118.64±14.86)mmH2O, (30.27±6.24)pg/ml, 8.24±0.13]; Calcitonin [(54.63±5.23)pg/ml, (64.64±5.23)pg/ml], the GOS prognostic score level [3.56±0.53, 5.67±0.56] was higher than pre-treatment [(34.94±3.53)pg/ml, 1.27±0.87], and the difference was statistically significant (F=20.510, 15.850, 4.367, 62.850, 28.080, 20.230; all P＜0.001). The arterial blood flow velocity [(98.73±15.20)mIU/ml, (68.74±9.21)mIU/ml], intracranial pressure [(74.53±13.07)mmH2O, (60.28±6.57)mmH2O], endothelin [(20.47±8.73)pg/ml, (12.48±1.74)pg/ml], Graeb score [6.02±0.24, 4.03±0.21] of combined treatment group 7 days, 14 days after surgery were lower than pretreatment [(170.31±18.57)mIU/ml, (118.57±14.93)mmH2O, (30.31±4.86)pg/ml, 8.26±0.57]; Calcitonin [(59.56±2.58)pg/ml, (74.57±5.49)pg/ml], the GOS prognostic score level [4.57±0.21, 6.24±0.23] was higher than the pre-treatment [(34.98±4.86)pg/ml, 1.31±0.83], and the difference was statistically significant (F=26.850, 20.110, 8.863, 32.600, 40.200, 23.300; all P＜0.001). Arterial flow velocity, intracranial pressure, complete clearance time of cerebral accumulation [(15.85±1.59)d vs (18.95±4.58)d], endothelin, Graeb score of combined treatment group after 7 d and 14 d lower than ventricular puncture drainage and treatment group, and the difference was statistically significant (t=5.598, 9.445; 4.587, 6.599; 5.729; 4.448, 12.870; 4.833, 2.540; P＜0.001, <0.001; <0.001, <0.001; <0.001; <0.001, <0.001; <0.001, =0.012); calcitonin and GOS prognosis score were higher than ventricular puncture drainage and treatment group, and the difference was statistically significant (t=7.608, 11.790, 15.940, 8.474; all P＜0.001); The overall clinical response rate in the combination treatment group (92.59%) was higher than that in the cerebral ventricular puncture and drainage treatment group (67.90%), there were statistical differences (χ2=15.570, P＜0.001).Conclusion:Subhypothermia combined with intraventricular puncture and drainage has a good effect on the treatment of senile high-grade aneurysmal subarachnoid hemorrhage, which can improve the cerebrovascular status, endothelin and calcitonin levels of patients, reduce the intraventricular hemorrhage, and promote the physical recovery of patients.
基金项目
2016年度湖南省卫生计生委科研计划课题(C2016019)
湖南省自然科学青年基金(2019JJ50313)
万方数据