经额血肿穿刺引流术治疗基底节脑出血手术时机探讨

Clinical Research on Time Window of Puncture and Drainage of Spontaneous Basal Ganglia Hemorrhage through Frontal Approach

目的:探讨不同手术时机经额血肿穿刺引流术治疗自发性基底节脑出血的疗效及对脑水肿的影响。方法:113例自发性基底节脑出血患者,根据发病后手术时机不同分为超早期组(<6h)31例、早期组(6～24h)42例和延期组(>24～72h)40例。比较3组术后常见并发症的发生率、血肿清除率、脑水肿体积变化、神经功能缺损评分(NIHSS)变化及远期疗效的差异。结果:3组术后常见并发症的发生率、残余血肿体积、血肿清除率和初始脑水肿体积比较差异无统计学意义;发病后7d脑水肿体积超早期组[(6.6±4.8)mL]和早期组([8.2±5.9)mL]明显小于延期组([15.8±15.4)mL]差异均有统计学意义(均P<0.01);手术后NIHSS改善超早期组[(11.3±6.0)分]和早期组([12.5±6.3)分]明显高于延期组([6.3±5.4)分],差异均有统计学意义(均P<0.01)。治疗后6个月ADL评分超早期组和早期组优于延期组(均P<0.01),但前2组间差异无统计学意义。结论:经额血肿穿刺引流术治疗可以有效清除血肿,早期手术能够减轻术后灶周水肿的程度并有利于患者神经功能恢复,再出血概率可能更小。

Objective： To investigate the clinical efficacy of puncture and drainage for the treatment of spontaneous basal ganglia hematoma through a catheter at frontal region at different time windows, and its impact on brain edema thereof. Methods： According to the time window of surgery, a total of 113 patients with spontaneous basal ganglia hematoma were divided into three groups including ultra-early group （n=31, surgery started 6 h）,early group （n=42, surgery started 6-24 h） and delayed group （n=40, surgery started 24-72 h）. The differences in incidence of common complications, the evacuation rate of blood clots, the volume change of brain edema, neurological deficit scores （NIHSS） and long-term follow-up results were compared in three groups. Results： There were no significant differences in the incidence of common complications, residual hematoma volume, evacuation rate of blood clots and initial brain edema volume between three groups. Seven days after the ictus, the edema volume was significantly smaller in ultra-early group （6.6±4.8） mL and early group （8.2±5.9） mL compared with that of delayed group （15.8±15.4） mL （P〈0.01）. The scores of NIHSS after operation were significantly higher in ultra-early group （11.3±6.0） and early group （12.5±6.3） than that of delayed group （6.3±5.4） （P〈0.01）. Six months after treatment, there were significantly more favorable daily living （ADL） scores in ultra-early group and early group than that of delayed group （P〈0.01）. But there was no significant difference between the ultra-early and early groups in these variables. Conclusion： The puncture and drainage through a catheter at frontal region for the treatment of spontaneous basal ganglia hematoma could remove blood clot effectively. Early surgery could alleviate the degree of perihematomal edema, improve neurological outcome and reduce the possibility of rebleeding.