摘要目的 探讨超早期小骨窗微创脑出血清除术对高血压性脑出血(HICH)患者术后血肿清除率及血清白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)水平的影响.方法 选择HICH患者93例,按手术方式分为观察组47例和对照组46例.观察组采取超早期小骨窗微创脑出血清除术治疗,对照组采取传统开颅血肿清除术治疗.统计对比两组手术情况、血肿清除情况、并发症发生情况及手术效果,并比较两组术前与术后3、14 d血清IL-6、MMP-9水平.结果 与对照组比较,观察组术中出血量更少,手术与住院时间更短(P均<0.05).观察组术后血肿清除率>90％比例与总有效率分别为57.45％、93.62％,均高于对照组的34.78％、76.09％,差异均有统计学意义(P均<0.05).术前两组血清IL-6、MMP-9水平比较差异未见统计学意义(P>0.05);术后3 d两组血清IL-6、MMP-9水平均较术前升高,但观察组低于对照组,差异有统计学意义(P<0.05);术后14 d两组上述指标水平均较术前降低,且观察组亦低于对照组,差异均有统计学意义(P均<0.05).观察组并发症发生率(4.26％)低于对照组(19.57％),差异有统计学意义(P<0.05).结论 超早期小骨窗微创脑出血清除术治疗高血压性脑出血疗效显著,可减轻手术创伤,提高血肿清除率,降低血清IL-6、MMP-9水平,加速患者术后恢复,减少并发症.

abstractsObjective To investigate the effect of ultra-early small bone window minimally inva-sive surgery for cerebral hemorrhage on postoperative hematoma clearance and levels of serum interleukin-6 (IL-6),matrix metalloproteinase-9 (MMP-9)in patients with hypertensive intracerebral hemorrhage (HICH). Methods Ninety-three patients with HICH were selected and divided into observation group (n = 47)and control group (n = 46)according to surgical procedures. Patients in observation group were treated by ultra-early small bone window minimally invasive cerebral hemorrhage surgery,and patients in control group were treated by the traditional craniotomy hematoma evacuation. Surgical conditions,hema-toma clearance,complications and surgical results were statistically compared between the two groups, and the serum levels of IL-6 and MMP-9 before operation and 3,14 days after operation were compared between the two groups. Results Compared with control group,blood loss in observation group was less,the operation time and hospital stay were shorter,and the differences were statistically significant (all P < 0. 05). The ratio of postoperative hematoma clearance rate > 90％ and the total effective rate in observation group was 57. 45％ and 93. 62％ respectively,which were higher than those in control group (34. 78％,76. 09％),the differences were statistically significant (all P < 0. 05). There was no signifi-cant difference in serum IL-6 and MMP-9 levels between the two groups before operation (P > 0. 05);the levels of serum IL-6 and MMP-9 in the two groups 3 d after operation were higher than those before opera-tion,and those in observation group were lower than those in control group,the differences were statisti-cally significant (all P < 0. 05);the levels of serum IL-6 and MMP-9 in the two groups 14 d after opera-tion were lower than those before operation,and those in observation group were lower than those in con-trol group,the differences were statistically significant (all P < 0. 05). The incidence of complications in observation group (4. 26％)was lower than that in control group (19. 57％),the difference was statisti-cally significant (P < 0. 05). Conclusions Ultra-early small bone window minimally invasive surgery for cerebral hemorrhage has significant effect on hypertensive intracerebral hemorrhage,which can reduce the surgical trauma,improve hematoma clearance,reduce serum IL-6,MMP-9 levels,contribute to the recovery of patients after surgery and reduce the incidence of complications.