CAJ | 학술논문

目的观察传统骨瓣开颅和微骨窗入路血肿清除术治疗高血压脑出血(HICH)的预后及其对细胞免疫的影响. 方法选择肇庆市第一人民医院神经外科自2008年9月至2012年5月手术治疗的HICH患者83例,其中采用传统骨瓣开颅血肿清除术53例(传统骨瓣开颅组),采用微骨窗入路血肿清除术30例(微骨窗入路组).分别于术前、术后1d、7d3个时间点检测患者血清CD3、CD4和CD8阳性细胞百分率和CD4/CD8,观察术后患者感染性并发症的发生并采用日常生活能力(ADL)分级评定患者预后. 结果与术前比较,2组患者术后1、7d血液CD3、CD4阳性细胞率和CD4/CD8比值降低,与术后1d比较,术后7dCD3、CD4阳性细胞率和CD4/CD8比值高,差异均有统计学意义(P＜0.05)；与传统骨瓣开颅组比较,微骨窗入路组患者术后1d、7 dCD3、CD4阳性细胞率和CD4/CD8比值较高,差异有统计学意义(P＜0.05)；传统骨瓣开颅组术后发生肺部感染率高于微骨窗入路组,差异有统计学意义(P＜0.05). 结论对于尚未发生脑疝的HICH,传统骨瓣开颅和微骨窗入路血肿清除术治疗预后相同,但微骨窗入路对患者细胞免疫的影响较小,可相对降低肺部感染的发生.
목적 관찰전통골판개로화미골창입로혈종청제술치료고혈압뇌출혈(HICH)적예후급기대세포면역적영향. 방법 선택조경시제일인민의원신경외과자2008년9월지2012년5월수술치료적HICH환자83례,기중채용전통골판개로혈종청제술53례(전통골판개로조),채용미골창입로혈종청제술30례(미골창입로조).분별우술전、술후1d、7d3개시간점검측환자혈청CD3、CD4화CD8양성세포백분솔화CD4/CD8,관찰술후환자감염성병발증적발생병채용일상생활능력(ADL)분급평정환자예후. 결과 여술전비교,2조환자술후1、7d혈액CD3、CD4양성세포솔화CD4/CD8비치강저,여술후1d비교,술후7dCD3、CD4양성세포솔화CD4/CD8비치고,차이균유통계학의의(P＜0.05)；여전통골판개로조비교,미골창입로조환자술후1d、7 dCD3、CD4양성세포솔화CD4/CD8비치교고,차이유통계학의의(P＜0.05)；전통골판개로조술후발생폐부감염솔고우미골창입로조,차이유통계학의의(P＜0.05). 결론 대우상미발생뇌산적HICH,전통골판개로화미골창입로혈종청제술치료예후상동,단미골창입로대환자세포면역적영향교소,가상대강저폐부감염적발생.
Objective To investigate the Effects of conventional open craniotomy and key-hole approach on neurosurgical management of hypertensive intracerebral hemorrhage (HICH) and on cellular immunal function of these patients.Methods Eighty-three patients with HICH,admitted to and performed operation in our hospital from September 2008 to May 2011 (53 underwent conventional open craniotomy and 30 underwent surgery via key hole approach) were chosen in our study.Their CD3,CD4 and CD8 positive cell percentage and ratio of CD4/CD8 in serum before operation and 1 and 7 d after operation were detected.The infectious complications were analyzed and prognoses were evaluated by activities of daily living (ADL) grading.Results The CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in serum 1 and 7 d after the operation were significantly decreased as compared with those before operation (P＜0.05),and those 7 d after operation were significantly increased as compared with those 1 d after operation (P＜0.05).One and 7 d after operation,the CD3 and CD8 positive cell percentage,and ratio of CD4/CD8 in the key hole approach group were significantly higher than those in the conventional open craniotomy group (P＜0.05).The postoperative pulmonary infection rate in the conventional open craniotomy group was significantly higher than that in the key hole approach group (P＜0.05).Conclusion As compared with conventional open craniotomy,surgery via key-hole approach has the same prognosis in treatment of HICH which has not yet occurred herniation,while the influence of cellular immunal function and the incidence of lung infection is relatively lower.