摘要：

目的 探讨亚低温疗法辅助立体定向血肿穿刺置管引流术对老年脑出血患者术后颅内压、神经功能和意识状况的保护作用。方法 共 116 例老年脑出血患者随机接受立体定向血肿穿刺置管引流术（对照组，58 例）和立体定向血肿穿刺置管引流术联合亚低温疗法（联合组，58 例），监测颅内压、血清 S-100B 蛋白和血糖水平，欧洲卒中量表（ESS）评价神经功能，Glasgow 昏迷量表（GCS）评价意识状况。结果 两组术后颅内压升高，至术后 3 d 达峰值，随即下降，至术后 7 d 时仍高于术后即刻（对照组 ：t = 55.232，P = 0.000；t = 74.233，P = 0.000；t = 67.583，P = 0.000；t = 59.642，P = 0.000；t = 52.852，P = 0.000；t = 45.865，P = 0.000；联 合 组 ：t = 28.765，P = 0.000；t = 54.233，P = 0.000；t = 33.402，P = 0.000；t = 27.379，P = 0.000；t = 16.122，P = 0.000；t = 7.444，P = 0.000）。术后 3、5 和 7 d 血清 S-100B 蛋白（对照组：t = 9.443，P = 0.000；t = 12.952，P = 0.000；t = 18.832，P = 0.000；联 合 组 ：t = 11.454，P = 0.000；t = 15.404，P = 0.000；t = 20.439，P = 0.000）和 血 糖（对 照 组 ：t = 11.580，P = 0.000；t = 14.592，P = 0.000；t = 17.482，P =
0.000；联合组：t = 12.343，P = 0.000；t = 15.231，P = 0.000；t = 19.631，P = 0.000）均低于术后即刻。术后 2、4、12、24 和 48 周 ESS 评分高于术后即刻（对照组：t = 30.533，P = 0.000；t = 39.273，P = 0.000；t = 43.853，P = 0.000；t = 48.924，P = 0.000；t = 53.322，P = 0.000；联 合 组 ：t = 38.943，P = 0.000；t = 43.595，P = 0.000；t = 49.923，P = 0.000；t = 52.594，P = 0.000；t = 58.943，P = 0.000）。术后 1 和 7 d GCS 评分均高于术前（对照组：t = 10.434，P = 0.000；t = 15.232，P = 0.000；联合组：t = 13.432，P = 0.000；t = 17.532，P = 0.000）。而联合组患者颅内压（F = 111.553，P = 0.000）、血清 S-100B 蛋白（F = 9.834，P = 0.000）和血糖（F = 8.094，P = 0.001）低于，ESS 评分（F = 10.689，P = 0.000）和 GCS 评分（F = 7.343，P = 0.007）高于对照组。两组患者病死率差异无统计学意义［6.90%（4/58）对5.17%（3/58）；校正χ² = 0.000，P = 1.000］，无一例发生硬膜外血肿和颅内感染等并发症。结论 亚低温疗法辅助立体定向血肿穿刺置管引流术可以降低老年脑出血患者颅内压，改善神经功能和意识状况，值得临床推广应用。

关键词: 脑出血, 引流术, 立体定位技术, 低温, 人工

Abstract:

Objective To analyze the effect of mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage on postoperative intracranial pressure (ICP) and neuroprotection in elderly patients with intracerebral hemorrhage (ICH). Methods A total of 116 elderly ICH patients randomly underwent stereotactic hematoma puncture and catheter drainage (control group, N = 58) and mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage (combination group, N = 58). ICP, serum S-100B protein (S-100B) and blood glucose were monitored. European Stroke Scale (ESS) was used to evaluate neurological function, and Glasgow Coma Scale (GCS) was used to assess conscious state. Results ICP increased after operation, and reached the peak on the 3rd day, and then decreased, but was still higher than immediately after operation on the 7th day in both groups (control group: t = 55.232, P = 0.000; t = 74.233, P = 0.000; t = 67.583, P = 0.000; t = 59.642, P = 0.000; t = 52.852, P = 0.000; t = 45.865, P = 0.000; combination group: t = 28.765, P = 0.000; t = 54.233, P = 0.000; t = 33.402, P = 0.000; t = 27.379, P = 0.000; t = 16.122, P = 0.000; t = 7.444, P = 0.000). The serum S-100B (control group: t = 9.443, P = 0.000; t = 12.952, P = 0.000; t = 18.832, P = 0.000; combination group: t = 11.454, P = 0.000; t = 15.404, P = 0.000; t = 20.439, P = 0.000) and blood glucose (control group: t = 11.580, P = 0.000; t = 14.592, P = 0.000; t = 17.482, P = 0.000; combination group: t = 12.343, P = 0.000; t = 15.231, P = 0.000; t = 19.631, P = 0.000) on the 3rd, 5th and 7th day in both groups were significantly lower than immediately after operation. The ESS scores 2, 4, 12, 24 and 48 weeks after operation were significantly higher than immediately after operation (control group: t = 30.533, P = 0.000; t = 39.273, P = 0.000; t = 43.853, P = 0.000; t = 48.924, P = 0.000; t = 53.322, P = 0.000; combination group: t = 38.943, P = 0.000; t = 43.595, P = 0.000; t = 49.923, P = 0.000; t = 52.594, P = 0.000; t = 58.943, P = 0.000). The GCS score on the 1st and 7th day after operation were significantly higher than before operation in both groups (control group: t = 10.434, P = 0.000; t = 15.232, P = 0.000; combination group: t = 13.432, P = 0.000; t = 17.532, P = 0.000). Compared with control group, ICP (F = 111.553, P = 0.000), serum S-100B (F = 9.834, P = 0.000) and blood glucose (F = 8.094, P = 0.001) were significantly lower, while ESS score (F = 10.689, P = 0.000) and GCS score (F = 7.343, P = 0.007) were significantly higher in combination group. There was no significant difference on the mortality between 2 groups [6.90% (4/58) vs. 5.17% (3/58); adjusted χ² = 0.000, P = 1.000]. No patient suffered from epidural hematoma or intracranial infection. Conclusions Mild hypothermia-assisted stereotactic hematoma puncture and catheter drainage can significantly reduce ICP in elderly ICH patients, and improve the neurological function and conscious state.

Key words: Cerebral hemorrhage, Drainage, Stereotaxic techniques, Hypothermia, induced