CAJ | 학술논문

【目的】探讨软通道颅内血肿微创清除术对脑出血继发脑损伤的影响及相关机制。【方法】选择本院首次发病且于起病24 h入院的高血压脑出血患者120例，随机分为三组，每组各40例。对照组采用保守治疗，硬通道组采用硬通道颅内血肿微创清除术治疗，软通道组采用软通道颅内血肿微创清除术治疗。治疗后d7、d14、d28行头颅C T检查及神经功能缺损评分，检测血中及引流脑脊液中白细胞介素‐6（IL‐6）、肿瘤坏死因子‐α（TNF‐α）、丙二醛（MDA）含量，超氧化物歧化酶（SOD）的活性。【结果】与对照组比较，硬通道组和软通道组d7、d14、d28血肿体积明显缩小，d7、d14、d28血肿周围脑水肿体积明显缩小，神经功能缺损评分明显改善（ P ＜0．05）；与硬通道组比较，软通道组d14、d28血肿体积及周围脑水肿体积明显缩小，d7、d14、d28神经功能缺损评分明显改善（ P ＜0．05），d2、d4、d6引流出脑脊液中IL‐6和TNF‐α含量均明显减低，血SOD活性升高和MDA含量降低（ P ＜0．05）。【结论】采用软通道微创治疗脑出血继发脑损伤患者，能促进血肿吸收、减轻血肿周围损伤、改善神经功能，其机制可能通过减轻脑出血后炎性反应、抑制氧化应激反应来实现。
【목적】탐토연통도로내혈종미창청제술대뇌출혈계발뇌손상적영향급상관궤제。【방법】선택본원수차발병차우기병24 h입원적고혈압뇌출혈환자120례，수궤분위삼조，매조각40례。대조조채용보수치료，경통도조채용경통도로내혈종미창청제술치료，연통도조채용연통도로내혈종미창청제술치료。치료후d7、d14、d28행두로C T검사급신경공능결손평분，검측혈중급인류뇌척액중백세포개소‐6（IL‐6）、종류배사인자‐α（TNF‐α）、병이철（MDA）함량，초양화물기화매（SOD）적활성。【결과】여대조조비교，경통도조화연통도조d7、d14、d28혈종체적명현축소，d7、d14、d28혈종주위뇌수종체적명현축소，신경공능결손평분명현개선（ P ＜0．05）；여경통도조비교，연통도조d14、d28혈종체적급주위뇌수종체적명현축소，d7、d14、d28신경공능결손평분명현개선（ P ＜0．05），d2、d4、d6인류출뇌척액중IL‐6화TNF‐α함량균명현감저，혈SOD활성승고화MDA함량강저（ P ＜0．05）。【결론】채용연통도미창치료뇌출혈계발뇌손상환자，능촉진혈종흡수、감경혈종주위손상、개선신경공능，기궤제가능통과감경뇌출혈후염성반응、억제양화응격반응래실현。
[Objective] To explore the effect and mechanism of minimally invasive soft channel intracranial hematoma removal for the treatment of brain injury secondary to cerebral hemorrhage .[Methods]Totally 120 patients with first onset and admitted to the hospital within 24h after the onset of hypertensive cerebral hemor‐rhage were randomly divided into 3 groups with 40 patients in each group .The control group received conser‐vative treatment .The hard channel group underwent hard channel intracranial hematoma removal ,while the soft channel group underwent soft channel intracranial hematoma removal . Head CT examination was per‐formed and neurological impairment score was observed on d7 ,d14 and d28 after treatment .The levels of inter‐leukin‐6(IL‐6 ) , tumor necrosis factor‐alpha (TNF‐α) , malondialdehyde (MDA ) and superoxide dismutase (SOD) in blood were measured .[Results]Compare with control group ,hematoma volume and the volume of peri‐hematoma injury area in hard channel group and soft channel group were obviously reduced on d 7 ,d14 and d28 ,and neurologic impairment was improved obviously ( P <0 .05) .Compare with hard channel group ,he‐matoma volume and the volume of peri‐hematoma injury area in soft channel group were obviously reduced on d7 ,d14 and d28 ,and neurologic impairment was improved obviously( P<0 .05) .The levels of IL‐6 and TNF‐αin efflux cerebrospinal fluid were obviously decreased on d2 ,d4 and d6 ,while blood SOD was increased and MDA was decreased( P <0 .05) .[Conclusion] Minimally invasive soft channel intracranial hematoma removal for the treatment of brain injury secondary to cerebral hemorrhage can promote hematoma absorption ,decrease the surrounding injury of hematoma and improve neurologic function .The mechanism may be related to the at‐tenuation of inflammatory response and the inhibition of oxidative stress response after cerebral hemorrhage .