锥颅血肿抽吸治疗高血压性脑基底核出血的疗效分析

Effectiveness of stereotaxic aspiration in treating hypertensive intracerebral hemorrhage of basal ganglion

目的旨在研究锥颅抽吸血肿治疗高血压性基底核区不同量脑出血的疗效.方法将81例脑基底核区出血的患者,分为锥颅血肿抽吸组(43例)和药物治疗组(38例),根据不同出血量,每组分成两个亚组,锥颅血肿抽吸组出血量40～80 ml为Ⅰa组28例,出血量＞80 ml为Ⅰb组15例;药物治疗组出血量40～80 ml为Ⅱa组25例,出血量＞80 ml为Ⅱb组13例.采用改良爱丁堡+斯堪的那维亚法对神经功能缺失程度进行评分(MESSS),所有患者于发病后30 d行疗效评定,采用等级资料的秩和检验、t检验进行统计学分析.结果Ⅰa组患者治疗前神经功能缺失评分为41.7±0.6,治疗后评分为18.9±2.4;Ⅱa组患者治疗前评分为41.6±0.8,治疗后评分为20.2±1.3;Ⅰb组患者治疗前神经功能缺失评分为42.1±0.6,治疗后评分为34.3±0.8;Ⅱb组患者治疗前评分为42.2±0.4,治疗后评分为34.5±0.7.Ⅰa组患者在有效性方面显著优于Ⅱa组患者,差异有显著意义(P＜0.05),Ⅰb组Ⅱb组患者的疗效差异无显著意义.结论对于出血量在40～80 ml的高血压性基底核区出血患者行锥颅血肿抽吸治疗,创伤小、疗效肯定,值得推广;而＞80 ml的脑出血,建议行外科常规手术,清除血肿.

Objective To investigate the effectiveness of stereotaxic aspiration in treating different volume hypertensive intracerebral hemorrhage of basal ganglion. Methods According to different volume of hemorrhage, 81 patients were divided into two groups; each group included the patient with stereotaxic aspiration and the patients under medical treatment without stereotaxic aspiration. The volume of hemorrhage of first group was 40 ~ 80 ml, 28 patients were underwent stereotaxic aspiration, 23 patients without aspiration; the volume of hemorrhage of second group was above 80 ml, 15 patients were underwent stereotaxic aspiration, 13 patients without aspiration. The curative effect for all patients were evaluated at 30 days after hemorrhage by MESSS. Wilcoxon Signed Ranks Test, u test were adopted to analysis the results. Results In the first group, the MESSS of patients with stereotaxic aspiration was 41. 7 ± 0.6 before treatment and 18. 9 ±2. 4 after treatment, the MESSS of patients without stereotaxic aspiration was 41. 6 ± 0. 8 before treatment and 20. 2 ±1.3 after treatment; In the second group, the MESSS of patients with stereotaxic aspiration was 42. 1 ± 0. 6 before treatment and 34. 3 ± 0. 8 after treatment, the MESSS of patients without stereotaxic aspiration was 42. 2±0.4 before treatment and 34. 5 ± 0. 7 after treatment. In the first group, the prognosis of patients with stereotaxic aspiration was much better than the patients without stereotaxic aspiration ( P < 0. 05). In the second group, there were no difference in statistics between the prognosis of patients with stereotaxic aspiration and that of patients without stereotaxic aspiration. Conclusion For patients with hypertensive basal ganlia hemorrhage are treated with stereotaxic aspiration is suitable if the volume of hemorrhage is 40 - 80 ml, because of the definite curative effect and minimally invasive. But it would be better to evacuate the hematoma with surgery if the volume of hemorrhage is above 80 ml.