摘要
目的探讨不同时点血管介入栓塞对蛛网膜下腔出血(SAH)患者脑组织损伤、神经功能及预后的影响。方法SAH患者98例根据手术时点不同进行分组,将入院72 h内行血管介入栓塞治疗患者纳入早期组(n=46),入院72 h后治疗的纳入晚期组(n=52);2组患者均行血管介入栓塞治疗,比较2组患者栓塞效果;于术前及术后第3天时采用酶联免疫吸附试验法检测2组患者血清中枢神经特异性蛋白S100β亚型(S100β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)等脑组织损伤指标和肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)、单核细胞趋化蛋白(MCP-1)等炎症因子水平;于术前及术后2周时采用美国院卒中量表(NIHSS)和改良Rankin量表(mRS)评估2组患者神经功能,记录2组患者术后并发症发生率,比较术后3个月患者预后恢复情况。结果术后早期组患者完全栓塞比例高于晚期组,差异有统计学意义(χ^(2)=4.981,P=0.026);术后3 d时2组SAH患者血清S100β、NSE、GFAP和MCP-1水平均术前降低,且早期组低于晚期组;TNF-α、CRP水平均较术前升高,且晚期组高于早期组,差异有统计学意义(P<0.05);术后2周时,2组SAH患者NIHSS评分、mRS评分均较术前降低,且早期组低于晚期组,差异有统计学意义(P<0.05);2组SAH患者并发症、院内致死率比较,差异均无统计学意义(χ^(2)=0.737、0.475,P>0.05);早期组恢复良好率高于晚期组,差异有统计学意义(χ^(2)=5.160,P=0.023)。结论早期血管介入治疗可以改善SAH患者脑组织损伤、炎症反应、神经功能状态和预后。
Objective To explore the effects of vascular interventional embolization at different time points on brain tissue injury,nerve function and prognosis in patients with subarachnoid hemorrhage(SAH).Methods According to different time points of interventional operation,98 patients with SAH were divided into early stage group(46 cases,vascular interventional embolization within 72 h after admission)and late stage group(52 cases,vascular interventional embolization 72 h after admission).The embolization effect was compared between the two groups.Before and on the 3 d after surgery,levels of brain tissue injury indexes[serum beta subunit of specific protein S100 protein(S100β),neuronal specific enolase(NSE),glial fibrillary acidic protein(GFAP)]and inflammatory factors[tumor necrosis factor(TNF-α),C-reactive protein(CRP),monocyte chemotactic protein(MCP-1)]were detected by enzyme-linked immunosorbent assay.Before and 2 weeks after surgery,nerve function was evaluated by National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)].The incidence of postoperative complications was recorded,and prognosis was compared between the two groups 3 months after surgery.Results After surgery,proportion of complete embolization in early stage group was higher than that in late stage group(χ^(2)=4.981,P=0.026).On the 3 d after surgery,levels of serum S100β,NSE,GFAP,and MCP-1 in both groups decreased,which were lower in early stage group than late stage group,while levels of TNF-αand CRP were increased,which were higher in early group than late group(P<0.05).At 2 weeks after surgery,NIHSS and mRS scores in both groups decreased,which were lower in early stage group than late stage group(P<0.05).There was no difference in the incidence of complications or in-hospital mortality between the two groups(χ^(2)=0.737,0.475;P>0.05).The good recovery rate in early stage group was higher than that in late stage group(χ^(2)=5.160,P=0.023).Conclusion Early vascular intervention can improve brain tissue injury,inflammat
作者
郭海志
王海滨
宋志刚
李小勇
王朝华
GUO Haizhi;WANG Haibin;SONG Zhigang;LI Xiaoyong;WANG Chaohua(Department of Neurology,Ziyang First People's Hospital,Ziyang 641300,Sichuan,China;Department of Neurosurgery,West China Hospital of Sichuan University,Chengdu 610000,Sichuan,China)
出处
《贵州医科大学学报》
CAS
2023年第10期1249-1254,共6页
Journal of Guizhou Medical University
基金
四川省科技厅重点研发项目(2021YFS0204)。
关键词
蛛网膜下腔出血
不同时点
脑组织损伤
神经功能
预后
subarachnoid hemorrhage
different timing
brain tissue injury
nerve function
prognosis
