脑立体定向微创技术治疗丘脑出血对患者运动诱发电位及神经功能的影响

Effects of minimally invasive procedures on motor evoked potential and motor function in patients with thalamic hematoma

目的用运动诱发电位(MEP)及神经功能评分观察立体定向微创技术清除颅内血肿对丘脑出血患者运动功能的影响。方法 21例丘脑出血患者随机分为微创手术组(MI组,10例患者)和药物治疗组(MT组,11例患者)。对MT组采用常规药物治疗,对MI组在入院后24 h内进行立体定向微创清除血肿治疗。对两组患者分别在入院时和入院后2周进行MEP测定,在入院时、入院后2周及1月进行神经功能评分。结果 MI组及MT组入院时运动功能明显减退,MEP潜伏期明显延长,MI组瘫痪上下肢MEP潜伏期分别为33.22±2.03和45.10±2.60 ms,MT组为32.92±3.12和44.80±2.48 ms,两者无明显差异。经过微创手术治疗后的所有患者MEP与MT组比较,潜伏期缩短,神经功能评分也明显减少,运动功能恢复。结论脑立体定向微创技术清除丘脑血肿能有效地减少患者运动功能的损害程度。

[ Objective ] To observe the changes in motor function using motor-evoked potential （MEP） and modi- fied National Institutes of Health Stroke Scale （mNIHSS） score in patients with thalamic hematoma treated by mini- really invasive procedures. [Methods] Twenty one patients with thalamic hematoma were randomized to either a minimally invasive group （MI group, including 10 patients） or a medical treatment group （MT group, including 11 patients）. The patients in the MI group underwent MEP measurements both before and 2 weeks after the thalamic hematoma was evacuated by minimally invasive procedures. The MEP ipsilateral to the hematoma side and the con- tralateral side were determined and then compared with the MT group. The mNIHSS was also determined on admis- sion, two weeks and one month after the patients were hospitalized. [ Results ] MEP was recorded simultaneously in all patients who were treated with minimally invasive procedures, and the latency of MEP decreased compared with the MT group. As MEP latency decreased, the mNIHSS score decreased after the surgery. [ Conclusion ] Minimally invasive procedures for thalamic hematoma evacuation could effectively reduce the degree of injury to the motor function as observed by a MEP measurement and a mNIHSS score.