[1]赵立辉,王立忠,袁进国,等.超早期小骨窗微创术治疗高血压脑出血疗效及对核因子-κB p65通路的影响[J].陕西医学杂志,2024,(6):797-800,805.[doi:DOI:10.3969/j.issn.1000-7377.2024.06.016]
　ZHAO Lihui,WANG Lizhong,YUAN Jinguo,et al.Efficacy of ultra-early small bone window minimally invasive surgery on hypertensive intracerebral hemorrhage and its effect on nuclear factor-κB p65 pathway[J].,2024,(6):797-800,805.[doi:DOI:10.3969/j.issn.1000-7377.2024.06.016]
点击复制

超早期小骨窗微创术治疗高血压脑出血疗效及对核因子-κB p65通路的影响
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2024年6期
页码:
797-800,805
栏目:
临床研究
出版日期:
2024-06-05

文章信息/Info

Title:
Efficacy of ultra-early small bone window minimally invasive surgery on hypertensive intracerebral hemorrhage and its effect on nuclear factor-κB p65 pathway
作者:
赵立辉; 王立忠; 袁进国; 袁 武; 侯 青; 孙慧渊; 王 唯
(张家口市第一医院神经外一科,河北 张家口 075000)
Author(s):
ZHAO Lihui; WANG Lizhong; YUAN Jinguo; YUAN Wu; HOU Qing; SUN Huiyuan; WANG Wei
(First Department of Neurosurgery,First Hospital of Zhangjiakou,Zhangjiakou 075000,China)
关键词:
高血压脑出血;  超早期小骨窗微创术;  创伤应激;  核因子-κB p65;  脑血流灌注;  安全性
Keywords:
Hypertensive cerebral hemorrhage;  Ultra-early small bone window minimally invasive surgery;  Traumatic stress;  Nuclear factor-κB p65;  Cerebral blood flow perfusion;  Safety
分类号:
R 743.34
DOI:
DOI:10.3969/j.issn.1000-7377.2024.06.016
文献标志码:
A
摘要:
目的:分析超早期小骨窗微创术治疗高血压脑出血的疗效及对核因子-κB p65(NF-κB p65)通路的影响。方法:选取高血压脑出血86例,根据手术时间不同分为观察组(46例,发病6 h内进行小骨窗微创颅内血肿清除术)和对照组(40例,发病6～24 h内进行小骨窗微创颅内血肿清除术)。比较两组临床疗效、围手术期指标、脑血流灌注指标、脑组织创伤应激指标、NF-κB p65通路相关因子以及并发症发生情况。结果:与对照组比较,观察组总有效率更高(P<0.05)。与对照组比较,观察组术中出血量更高,但意识恢复时间、下床时间、住院时间更短(均P<0.05)。与术前比较,术后7 d两组大脑中动脉舒张压末期血流速度(EDV)、收缩期峰值流速(PSV)水平以及血清脑源性神经营养因子(BDNF)水平升高,且观察组更高; 两组大脑中动脉阻力指数(RI)、患侧颈总动脉外周阻力(R)降低,血清血清神经肽Y(NPY)、星形胶质源性蛋白(S100β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、NF-κB p65水平降低,且观察组更低(均P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。结论:相对于发病6～24 h进行手术,发病6 h内的超早期小骨窗微创术疗效更好,不但可以改善患者围手术期指标,降低创伤应激,改善脑血流灌注,还可以调控NF-κB p65通路,安全性更高。
Abstract:
Objective:To analyze the efficacy of ultra-early small bone window minimally invasive surgery in treatment of hypertensive cerebral hemorrhage and its effect on nuclear factor-κB p65(NF-κB p65)pathway.Methods:A total of 86 patients with hypertensive intracerebral hemorrhage were divided into observation group(46 cases,underwent small bone window minimally invasive intracranial hematoma removal within 6 hours of onset)and control group(40 cases,underwent small bone window minimally invasive intracranial hematoma removal within 6 to 24 hours of onset).The clinical efficacy,perioperative indicators,cerebral blood flow perfusion indicators,traumatic stress indicators of brain tissue,NF-κB p65 pathway-related factors and complications were compared between two groups.Results: The total effective rate in observation group was higher than that in control group(P<0.05).Compared with control group,the intraoperative blood loss was higher,but the recovery time of consciousness,time to get out of bed,and length of hospital stay were shorter in the observation group(all P<0.05).Compared with pre-operation,the levels of EDV,PSV of middle cerebral artery and serum BDNF were increased 7 days after operation in the two groups,and the observation group was higher; the RI of the middle cerebral artery and R of the common carotid artery on the affected side in the two groups decreased,and the serum levels of NPY,S100β,IL-6,TNF-α,and NF-κB p65 decreased,and the observation group was lower(all P<0.05).The total incidence of complications during hospitalization in the observation group was lower than that in control group(P<0.05).Conclusion:Compared with surgery performed within 6 to 24 hours of onset,small bone window minimally invasive surgery performed within 6 hours of onset has better efficacy.It can not only improve perioperative indicators,reduce traumatic stress,improve cerebral blood perfusion,but also regulate NF-κB p65 pathway,with higher safety.

参考文献/References:

[1] 郑琳静,李海云,马晶晶,等.4212例出血性脑卒中病例流行特征及近期预后影响因素分析[J].华南预防医学,2022,48(9):1158-1160.
[2] XU Z,SUN Z,XU M,et al.The effect of small bone window craniotomy removal on lactic acid and CRP in patients with hypertensive intracerebral hemorrhage in the basal ganglia[J].Neurol India,2022,70(5):2047-2052
[3] 李照建.高血压脑出血的手术治疗[J].中国医刊,2020,55(4):354-356.
[4] 王浩,李栋,丁娇.小骨窗显微手术在老年高血压脑出血患者中的应用效果及对其神经功能和血清S100B、NSE、BDNF水平的影响[J].临床和实验医学杂志,2022,21(22):2380-2383.
[5] SHAO X,WANG Q,SHEN J,et al.Comparative study of micro-bone window and conventional bone window microsurgery for hypertensive intracerebral hemorrhage[J].J Craniofac Surg,2020,31(4):1030-1033.
[6] 龙晓东,刘之彝,杨与敏.超早期小骨窗微创颅内血肿清除术对高血压脑出血患者生活质量和ET、AVP水平的影响[J].脑与神经疾病杂志,2019,27(3):169-173.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2019)[J].中华神经科杂志,2019,52(12):994-1005.
[8] 孙龙,董致郅,王革生,等.凉血散瘀汤对高血压脑出血微创术后患者中医症候积分、神经功能缺损评分的影响[J].陕西中医,2023,44(8):1061-1064.
[9] 孙龙,董致郅,王革生,等.凉血散瘀汤对高血压脑出血微创术后患者中医症候积分、神经功能缺损评分的影响[J].陕西中医,2023,44(8):1061-1064.
[10] 徐宣乐,李学超,王琼,等.单通道、软-硬通道结合微创血肿穿刺引流术与神经内镜下血肿清除术治疗高血压脑出血临床疗效研究[J].陕西医学杂志,2021,50(8):977-982.
[11] 杨生琴.超早期小骨窗微创脑出血清除术后血清VEGF、Ang-1、HPA水平变化及意义[J].陕西医学杂志,2019,48(1):48-51.
[12] MEN D,HUANG Z,YIN Y,et al.Advantages of small bone-window craniotomy under microscope combined postoperative intracranial pressure monitoring in the treatment of hypertensive intracerebral hemorrhage[J].J Craniofac Surg,2021,32(1):e77-e80.
[13] WU R,BAO J,ZHANG J,et al.Clinical effects of neuroendoscopic hematoma evacuation for hypertensive intracerebral hemorrhage[J].Am J Transl Res,2022,14(2):1084-1091.
[14] 夏芹,覃凡,刘泓渊,等.小骨窗开颅血肿清除术与神经内镜下经外侧裂入路血肿清除术治疗高血压脑出血疗效对比[J].中国实用神经疾病杂志,2023,26(9):1156-1161.
[15] 隋曌,严小虎,李英.超早期小骨窗微创血肿清除术治疗高血压脑出血效果及对血清血管内皮生长因子、血管生成素1和炎性因子影响[J].临床误诊误治,2020,33(2):85-89.
[16] 孙德超,李振江,孔晨旭,等.高血压脑出血患者血清S100钙结合蛋白B表达水平及其对预后评估价值研究[J].临床军医杂志,2021,49(12):1391-1393.
[17] 邵政,柳泽彬,肖铮铮,等.不同手术时机小骨窗微创血肿清除术对高血压脑出血患者炎症因子、预后及血清Ang-1、ET、AVP水平的影响[J].现代生物医学进展,2021,21(20):3979-3983.
[18] 张姗姗,甄志勇.超早期小骨窗微创术对高血压脑出血的疗效及对血清VEGF、Ang-1水平和神经功能指标的影响分析[J].解放军医药杂志,2021,33(6):54-58.
[19] 黄国洲,廖振南,利文倩,等.手术方式和小骨窗微创手术治疗时间的选择对高血压脑出血患者疗效及生活质量的影响[J].河北医科大学学报,2021,42(10):1215-1220.
[20] 周子扬,高山,倪萌.内镜及显微手术方式对基底节区高血压脑出血治疗的效果观察探究[J].生命科学仪器,2023,21(1):84-84.
[21] 郑立冲,李民,尹春风,等.小骨窗显微术治疗高血压脑出血效果观察[J].山东医药,2023,63(14):73-75.
[22] LV K,WANG Y,CHAO H,et al.Comparison of the efficacy of subosseous window neuro-endoscopy and minimally invasive craniotomy in the treatment of basal ganglia hypertensive intracerebral hemorrhage[J].J Craniofac Surg,2023,34(8):e724-e728.
[23] MAO Y,SHEN Z,ZHU H,et al.Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage[J].Ann Palliat Med,2020,9(2):339-345.
[24] 孙鹏,邢栋,杨文博,等.超早期小骨窗脑出血清除术对高血压脑出血患者术后氧化应激及预后的影响[J].中华实验外科杂志,2022,39(9):1760-1762.
[25] 王铁峰,王刚,崔海随,等.小骨窗开颅血肿清除术与微创血肿碎吸术治疗高血压脑出血的临床疗效比较[J].现代生物医学进展,2019,19(3):502-505,559.

相似文献/References:

[1]刘鹏程,罗有才,纪文军,等.立体定向-改良软通道微创介入颅内血肿清除术对高血压脑出血患者血清NSE、S100B、炎症因子水平及预后的影响[J].陕西医学杂志,2020,49(3):321.
　LIU Pengcheng,LUO Youcai,JI Wenjun,et al.Effects of stereoscopic orientation-modified soft-channel minimally invasive intervention intracranial hematoma evacuation on serum NSE,S100B,inflammatory factor levels and prognosis in patients with hypertensive intracerebral hemorrhage[J].,2020,49(6):321.
[2]徐宣乐,李学超,王 琼,等.单通道、软-硬通道结合微创血肿穿刺引流术与神经内镜下血肿清除术治疗高血压脑出血临床疗效研究[J].陕西医学杂志,2021,50(8):977.[doi:DOI:10.3969/j.issn.1000-7377.2021.08.019]
[3]张 彬,马京库.高血压脑出血钻孔引流术后预后影响因素分析[J].陕西医学杂志,2022,51(4):470.[doi:DOI:10.3969/j.issn.1000-7377.2022.04.020]
　ZHANG Bin,MA Jingku.Prognostic influencing factors of patients with hypertensive intracerebral hemorrhage after drilling and drainage[J].,2022,51(6):470.[doi:DOI:10.3969/j.issn.1000-7377.2022.04.020]
[4]曹 宁,王文涛.神经内镜下不同入路方式治疗高血压脑出血疗效及患者疾病近期预后比较[J].陕西医学杂志,2022,51(9):1106.[doi:DOI:10.3969/j.issn.1000-7377.2022.09.014]
[5]李 民,刘晓斌,曹 杰,等.老年高血压脑出血患者卒中相关性肺炎病原学特点及危险因素分析[J].陕西医学杂志,2023,52(1):62.[doi:DOI:10.3969/j.issn.1000-7377.2023.01.014]
　LI Min,LIU Xiaobin,CAO Jie,et al.Etiologic features and risk factors of stroke-associated pneumonia in elderly patients with hypertensive intracerebral hemorrhage[J].,2023,52(6):62.[doi:DOI:10.3969/j.issn.1000-7377.2023.01.014]
[6]王 强,王 萃,赵 燕,等.高血压脑出血术后脑水肿患者血清CC类趋化因子配体5和纤维蛋白原样蛋白2水平变化及意义[J].陕西医学杂志,2023,52(9):1181.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.015]
　WANG Qiang,WANG Cui,ZHAO Yan,et al.Changes and significance of serum CCL5 and FGL2 levels in patients with cerebral edema after hypertensive cerebral hemorrhage surgery[J].,2023,52(6):1181.[doi:DOI:10.3969/j.issn.1000-7377.2023.09.015]
[7]王 涛,张艳达,霍继珍,等.血清神经元特异性烯醇化酶和D-二聚体在高血压脑出血术后神经功能障碍患者中的表达水平及检测意义[J].陕西医学杂志,2024,(5):658.[doi:DOI:10.3969/j.issn.1000-7377.2024.05.018]
　WANG Tao,ZHANG Yanda,HUO Jizhen,et al.Expression levels and significance of serum neuron-specific enolase and D-dimer in patients with neurological dysfunction after surgery of hypertensive intracerebral hemorrhage[J].,2024,(6):658.[doi:DOI:10.3969/j.issn.1000-7377.2024.05.018]

备注/Memo

备注/Memo:
基金项目:河北省卫生健康委员会医学科学研究课题(20191722)
更新日期/Last Update: 2024-06-05