脑立体定向微创手术治疗高血压脑出血

minimally invasive surgery with stereotactic technique in the treatment of hypertensive intracerebral hemorrhage

目的观察脑立体定向微创手术治疗高血压脑出血的疗效及微创治疗对血脑屏障的影响。方法56例高血压脑出血患者随机分成2组：立体定向微创治疗组和内科常规治疗组,每组28例。测定正常对照组患者和高血压脑出血患者发病后2周的血脑屏障指数,并进行临床神经功能缺损评分。结果脑立体定向微创治疗组及内科常规治疗组患者入院时临床神经功能缺损程度评分分别为35．52±7．43、37．18±6．24,两者比较无显著差异(P＞0．05)；治疗后2周的临床神经功能缺损程度评分分别为21．89±9．45、34．58±11．23,两者比较有显著性差异(P＜0．05)；治疗后4周临床神经功能缺损程度评分分别为7．32±1．22、10．43±2．25,两者比较有显著性差异(P＜0．05)。正常对照组、内科常规治疗组和脑立体定向微创治疗组的血脑屏障指数分别为0．0062±0．0003、0．0087±0．0007、0．0073±0．0008,内科常规治疗组和立体定向微创治疗组与正常对照组比较,均有显著性差异(P＜0．05),立体定向微创治疗组与内科常规治疗组比较,有显著性差异(P＜0．05)。结论脑立体定向微创手术能减轻高血压脑出血血脑屏障的破坏,与内科常规治疗组比较有较好的近期疗效。

Objective To observe the effect of minimally invasive surgery with stereotactic technique in the treatment of hypertensive intracerebral hemorrhage （HICH） and explore the mechanism. Methods Fitly-six cases with HICH were randomly divided into 2 groups （n=28）： medical treatment group （conventional group） and minimally invasive surgery group （experimental group）. Twelve healthy volunteers served as normal controls. The blood-brain barrier （BBB） index was assessed in normal controls and HICH patients 2 weeks after onset. Meanwhile, the clinical neurologic impairment scale was evaluated. Results The scores of neurologic impairment scale were 35.52±7.43 and 37.18±6.24 on admission in conventional group and experimental group, respectively, and no statistically significant difference was found between them （P〉0.05）; 2 weeks after treatment, the scores were 21.89±9.45 and 34.58±11.23, respectively, being significantly different between the 2 groups （P〈 0.05）; 4 weeks after treatment, the scores were reduced to 7.32±1.22 and 10.43±2.25, respectively, still being significantly different between the two （P〈 0.05）. The BBB indices were 0.0062±0.0003, 0.0087±0.0007 and 0.0073±0.0008 respectively in normal control group, conventional group and experimental group; the significant differences were found among the 3 groups （P〈 0.05）. Conclusion Minimally invasive surgery with stereotactic technique can reduce the lesion of cytotoxicity to BBB in HICH patients and improve the prognosis.