Study On The Curative Effect Of Two Kinds Of Micro-invasive Surgery On Patients With Hypertensive Intracerebral Hemorrhage In Basal Ganglia And The Correlation Of NSE

Objective:Explore the curative effect difference between the "keyhole" craniotomy andpuncture surgery in the treatment of hypertensive cerebral hemorrhage in basal ganglia (hypertensive intracerebral hemorrhage, HICH) and the correlation of serum neuron specific enolase (neuron-specific enolase, NSE).Method:Set up "keyhole" craniotomy operation group, puncture surgery group and the normal group.Choose 68 patients withHICH in basal ganglia when according with the selected condition,then divided them into "keyhole" craniotomy group (hereinafter called keyhole group) and puncture surgery group (hereinafter called the puncture group).Besides,20 healthy people were randomly selected as normal control group used fordetermination of the normal serum NSE. Make a comparison ofthe differences in operation time, hematoma clearance rate, operation complications, operative blood loss and mortality. Measure the changes of serum concentration ofNSE and observatethe NIHSS of the two groupsat the postoperative days 3、7 and 14 dynamically.Accordingly, assess the neurologic impairment by using American National Institutes of Health Stroke Scale (NIHSS) and analyze the correlation between serum NSE level and NIHSS score.Compare the difference of short-term prognosis between the two groups at 28th day by using the Barthel IndexResults:1.There were significantly differences between two groups in operation time, hematoma clearance rate, operative blood lossand extubation time (P< 0.05)It showed no significant differences when compared in the operation complications and mortality (P> 0.05), but the keyhole group hada lower incidence than the puncture group. Keyhole group’s ADL scored higher than the puncture group at 28d follow-up after operation, which showed a significant difference (P< 0.05).2. Both serum NSE level and NIHSS score reached the peak 3 days after operationand decreasedgradually on postoperative days 7,14.The puncture group declinedmore slowly than the keyhole group obviously, and the postoperative 7d and 14d showed significant difference (P＜0.05), Repeated measures analysis of variance revealed statistical significant difference (P＜0.05).3. NIHSS score and NSE content showed significantly positive correlation in both two groups on the postoperative days 3、7、14, (0<r<1, P＜0.05), but the two groups’ preoperative NIHSS score and the level of NSE had no significant correlation (P> 0.05).Conclusion:1. As to the patients who have suffered HICH in basal ganglia, both two kinds of micro-invasive surgeries are equally effective when the volume of hematoma is in the range of 30-60ml, without breaking into ventricle and encephaloma,but patients in keyhole surgery group have a faster recovery compared with the puncture surgery group.Regarding it as a whole, the keyhole surgery has more advantages than the punchture surgery,which we can consider" keyhole" approach as our first choice.2. The dynamic expression of serum NSE is positively correlated to the neurologic impairment,therefore,it can be used to evaluate the clinical curative effect and near-term prognosis of two types of micro-invasive surgery objectively...