钻孔内镜下微创手术对高血压脑出血患者血清去甲肾上腺素、5-羟色胺和神经功能的影响

Effect of minimally invasive endoscopic surgery through burr hole on serum norepinephrine, 5-hydroxytryptamine and neurological function in patients with hypertensive cerebral hemorrhage

摘要:

目的 探讨钻孔内镜下微创手术对高血压脑出血患者血清去甲肾上腺素（NE）、5-羟色胺（5-HT）和神经功能的影响。方法 回顾性分析2017年11月－2020年11月该院92例高血压脑出血患者的临床资料，依据治疗方案不同分为观察组和对照组，各46例。观察组行钻孔内镜下微创手术，对照组行软通道穿刺抽吸引流。对比两组患者手术相关指标；比较两组患者术前、术后1和7 d血浆肾素活性（PRA）、血管紧张素Ⅱ（Ang Ⅱ）、醛固酮（ALD），血清白细胞介素-6（IL-6）、C反应蛋白（CRP）、NE和5-HT水平；比较术前、术后7和30 d美国国立卫生研究院卒中量表（NIHSS）、斯堪的纳维亚卒中量表（SSS）评分及术后3个月预后情况。结果 观察组手术时间长于对照组（P < 0.05），术中出血量多于对照组（P < 0.05），血肿清除率高于对照组（P < 0.05）；术后7和30 d，观察组NIHSS评分较对照组低，SSS评分较对照组高（P < 0.05）；观察组术后1 d血清IL-6、CRP及PRA、Ang Ⅱ和ALD水平高于对照组（P < 0.05），术后7 d血清IL-6、CRP及PRA、AngⅡ和ALD水平低于对照组（P < 0.05）；观察组术后1和7 d血清NE和5-HT水平高于对照组（P < 0.05）；两组患者术后3个月均无死亡病例，观察组预后优于对照组（P < 0.05）。结论 高血压脑出血患者行钻孔内镜下微创手术，可调节患者血清炎性因子，恢复肾素-血管紧张素系统，血肿清除率较高，减少血肿对NE、5-HT的抑制及相关不利影响，促进神经功能恢复，有助于改善患者预后。

Abstract:

Objective To explore the effect of minimally invasive surgery under drilling endoscopy on serum norepinephrine (NE), 5-hydroxytryptamine (5-HT) and nerve function in patients with hypertensive cerebral hemorrhage.Methods From November 2017 to November 2020, 92 patients with hypertensive intracerebral hemorrhage in our hospital were retrospectively selected and divided into two groups according to the different treatment plan, each group with 46 cases. Minimally invasive surgery under drilling endoscopy in the observation group, and soft channel puncture and drainage in the control group. Observation and comparison of surgical-related indicators; Plasma renin activity (PRA), angiotensin Ⅱ (Ang Ⅱ) and aldosterone (ALD), serum interleukin-6 (IL-6), C-reaction protein (CRP), NE and 5-HT levels before operation, 1 d and 7 d after operation; Preoperative, postoperative 7 d and 30 d The National Institutes of Health Stroke Scale (NIHSS) and Scandinavia Stroke Scale (SSS), and prognosis at 3 months after operation.Results The operation time of the observation group was longer than that of the control group (P < 0.05), the intraoperative blood loss and hematoma clearance rate were higher than those of the control group (P < 0.05). The NIHSS score of the observation group was lower than that of the control group at 7 and 30 d after surgery. The SSS score was higher than that of the control group (P < 0.05); The serum IL-6, CRP and PRA, Ang II, ALD levels of the observation group were higher than those of the control group at 1 d after operation (P < 0.05), and the serum IL-6, CRP, PRA, Ang Ⅱ and ALD levels were lower at 7 days after operation (P < 0.05); The serum NE and 5-HT levels of the observation group were higher than those of the control group on the 1st and 7th day after operation (P < 0.05); There was no death in both groups 3 months after operation, and the prognosis of the observation group was better than that of the control group (P < 0.05).Conclusion Minimally invasive drilling endoscopic surgery for patients with hypertensive intracerebral hemorrhage, can significantly adjust the serum inflammatory factors and renin-angiotensin system, with a higher hematoma clearance rate, and reduce the inhibition related adverse effects of NE and 5-HT by hematoma. It can promote the recovery of nerve function and help improve the prognosis of patients.