[1]唐 韬,胡国良.内镜辅助下血肿清除加去骨瓣减压术对脑出血后患者细胞免疫及神经功能的影响研究*[J].陕西医学杂志,2018,(12):1551-1555.
　Tang Tao,Hu Guoliang.Effects of endoscopic assisted hematoma clearance plus bone flap decompression on cellular immunity and nerve function after intracerebral hemorrhage[J].,2018,(12):1551-1555.
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内镜辅助下血肿清除加去骨瓣减压术对脑出血后患者细胞免疫及神经功能的影响研究*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2018年12期
页码:
1551-1555
栏目:
临床研究
出版日期:
2018-12-31

文章信息/Info

Title:
Effects of endoscopic assisted hematoma clearance plus bone flap decompression on cellular immunity and nerve function after intracerebral hemorrhage
文章编号:
DOI:10.3969/j.issn.1000-7377.2018.12.011
作者:
唐 韬; 胡国良
延安大学附属医院神经外科（延安716000）
Author(s):
Tang Tao; Hu Guoliang
Neurosurgery of Yan’an University Affiliated Hospital (Yan’an 716000)
关键词:
脑出血/外科学 减压颅骨切除术 血肿; 硬膜下 神经内窥镜检查
Keywords:
Key words Brain hemorrhage/surgery Decompression craniectomy Hematoma; subdural Neuroendoscopy
分类号:
R651.1
文献标志码:
A
摘要:
摘 要 目的:探究内镜辅助下血肿清除加去骨瓣减压术对脑出血患者细胞免疫及神经功能的影响。方法:选取急性脑出血患者86例，将其随机分为观察组（43例）和对照组（43例）。对照组接受常规手术治疗，观察组患者接受内镜辅助下血肿清除加去骨瓣减压术治疗。比较两组患者的脑内血肿的清除情况、治疗前后格拉斯哥转归量表（GOS）、Barthel（BI）指数以及NIHSS评分变化情况，同时对患者细胞免疫功能进行监测分析。结果:观察组术后血肿再发率（0%）低于对照组(11.63%)，差异存在统计学意义（P＞0.05）。两组脑内血肿清除率比较差异具有统计学意义（P＜0.05）。观察组预后良好率达到37.21%，对照组达39.53％，两组相比差异具有统计学意义（P＞0.05）。两组术后３个月和６个月BI值显示，观察组优于对照组（P＜0.05）。与手术前比较，两组患者在术后1、7d血液CD3、CD4阳性细胞率和CD4/CD8比值均降低，与术后1d比较，患者在术后7d的 CD3、CD4及CD4／CD8比值升高（P<0.01）。CD8阳性细胞率在不同日期进行比较均差异无统计学意义（P＞0.05）；与对照组比较，研究组在术后1 d和7 d，CD3、CD4和CD4／CD8比值均较高（P<0.01）。治疗2周和治疗2个月后，对照组和观察组神经功能相比，差异具有统计学意义（P<0.01）。结论:内镜辅助下血肿清除加去骨瓣减压术能有效改善患者神经功能，降低手术对患者细胞免疫功能的影响。
Abstract:
Abstract Objective: To study the effects of endoscopic assisted hematoma clearance plus bone flap decompression on cellular immunity and nerve function after intracerebral hemorrhage.Methods:86 cases of acute cerebral hemorrhage patientswere randomly divided into 2 groups, 43 cases in the observation group, 43 cases in the control group.The control group received routine treatment, and the patients in the observation group were treated with endoscopic assisted hematoma clearance plus bone flap decompression. The clearance of intracerebral hematoma in the two groups was compared. The changes of Glasgow Outcome Scale (GOS), Barthel (BI) index and NIHSS score in two groups before and after treatment were analyzed and compared. Meanwhile, the cellular immune function of patients in the two groups was monitored. Results:The recurrence rate of postoperative hematoma in the observation group (0%) was lower than that in the control group (11.63%),there was no significant difference in recurrence rate between the two groups (P＞0.05).The observation group of patients with complete clearance of hematoma in 21 cases, mostly removed in 17 cases, partial removal in 5 cases, the control group of patients with complete clearance of hematoma in 16 cases, mostly removed in 17 cases, partial removal in 10 cases, and intracerebral hematoma rate had significant difference between the 2 groups of patients with intracerebral hematoma removal rate there was significant difference (P<0.05). The good prognosis of the patients in the observation group was 37.21%, the prognosis of the control group was 39.53%, and there was no significant difference between the two groups (P>0.05). The BI value of the two groups after 3 months and 6 months showed that the observation group was better than〖LM〗 the control group (P< 0.05). CD3 positive rate and CD4/CD8 ratio in serurn of 2 groups were decreased at 1 and 7d after operation compared with those before operation. CD3, CD4 and the ratio of CD4/CD8 patients in the two groups increased at 7d after operation compared with postoperative 1d, the difference was statistically significant (P<0.01) in the 1 groups. There was no significant change in the positive cell rate of CD8 at different dates. The difference was not statistically significant (P>0.05). Compared with the control group, CD3, CD4 and the ratio of CD4 /CD8 in the study group was higher than that in the control group at 1 d and 7 d (P<0.01). After 2 weeks of treatment and 2 months of treatment, there was a very significant difference in neurological function between the control group and the observation group (P<0.01). Conclusion: Endoscopic assisted evacuation of hematoma and decompressive craniectomy can effectively improve the neurological function and reduce the effect of surgery on the cellular immune function of patients.

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备注/Memo

备注/Memo:
*陕西省自然科学基础研究计划项目(2014JM4102)
更新日期/Last Update: 2019-01-21