经额部微创钻孔引流术治疗基底核区高血压性脑出血临床疗效及再出血影响因素分析

Clinical effect of minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage in basal ganglia and analysis of influencing factors of rebleeding

目的 探讨经额部微创钻孔引流术治疗基底核区高血压性脑出血(HICH)患者的临床疗效,并分析患者术后再出血的危险因素。方法 分析2015年3月至2018年3月本院神经外科收治的基底核区HICH患者98例临床资料,患者均经额部行微创钻孔引流术治疗,统计两组治疗效果,并将再出血患者纳入观察组,未复发患者纳入对照组,统计两组患者一般资料,采用t或χ^2分析患者术后再出血的危险因素,采用多因素Logistic回归分析再出血高危因素。结果 患者术后3d和7d的血肿残余量分别为(23.64±3.96)ml、(10.72±1.29)ml,患者术后24h内再出血率为13.27%,患者术后3个月的NIHSS评分、ADL-Barthel评分分别为(18.96±2.17)分、(67.13±9.91)分,均较术前显著改善(P<0.05),患者NIHSS评分优良率为60.20%,ADL-Barthel评分优良率为58.16%;单因素分析发现,观察组和对照组性别、年龄、术前血肿量、术中活动性出血率,差异比较无统计学意义(P>0.05),对照组发病至手术时间显著短于观察组(P<0.05),术前收缩压显著低于观察组(P<0.05);多因素Logistic回归分析发现,发病至手术时间和术前收缩压均为影响基底核区HICH经额部微创钻孔引流术后再出血的独立危险因素。结论 经额部微创钻孔引流治疗基底核区HICH疗效确切,可显著改善患者神经功能,提高患者生活质量,发病至手术时间和术前收缩压为基底核区HICH经额部微创钻孔引流术后再出血的危险因素。

Objective To explore the clinical efficacy of minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage(HICH) in the basal ganglia, and to analyze the risk factors of postoperative rebleeding. Method Retrospectively analyzed the clinical data of 98 patients with HICH in the basal ganglia treated by neurosurgery from March 2015 to March 2018, patients with rebleeding were included in the observation group, patients without recurrence were included in the control group, the general data of the two groups were analyzed, risk factors of postoperative rebleeding were analyzed by t or χ^2, Multivariate Logistic regression was used to analyze the risk factors of rebleeding. Results The residual amount of hematoma at 3d and 7d after surgery was( 23.64±3.96) ml an( 10.72±1.29) ml, and the rebleed rate was 13.27% within 24 hours after surgery. The NIHSS score and ADL-Barthel score of patients at 3 months after operation were( 18.96±2.17) and( 67.13±9.91), respectively, which were significantly improved compared with preoperative( P<0.05), the excellent and good rate of NIHSS score was 60.20%, and the excellent and good rate of ADL-Barthel score was 58.16%. Univariate analysis found that there was no significant difference in gender, age, preoperative hematoma volume, and intraoperative active bleeding rate between the observation group and the control group( P>0.05). The incidence of the control group to the operation time was significantly shorter than that of the observation group( P<0.05), and the preoperative systolic blood pressure was significantly lower than that of the observation group( P<0.05). Multivariate Logistic regression analysis found that the onset time to surgery and preoperative systolic blood pressure were independent risk factors for rebleeding after minimally invasive drainage of HICH in the basal ganglia. Conclusion Minimally invasive drainage of the forehead for the treatment of HICH in the basal ganglia is effective, can significantly improve the patient's neurological function, improve the quality of life of patients, risk factors from onset to operative time and preoperative systolic pressure to rebleeding after minimally invasive drainage of HICH in the basal ganglia.