CT定向穿刺术治疗高血压基底节区出血时机的选择及其对患者预后的影响

Opportunity of treatment of hypertensive basal ganglia hemorrhage by CT-guided stereotaxic transcranial puncture drainage

目的探讨CT定向穿刺技术治疗高血压基底节区出血时机的选择及其对患者预后的影响。方法 2007年5月至2010年10月收治经CT证实为高血压基底节区出血且出血量为30～60ml的患者109例,均采取CT定向脑内血肿穿刺术治疗,按手术时机分为三组:A组从发病到手术时间≤6h,B组6～24h,C组24～72h。比较三组患者术后3d内再出血率、术后3个月死亡率及日常生活能力(ADL)分级。结果 A组患者术后再出血率(20.00%,8/40)明显高于B组(4.55%,2/44)和C组(0.00%)(P<0.05),而B组和C组之间无明显差异(P>0.05);术后3月C组死亡率(36.00%,9/25)明显高于B组(4.55%,2/44)和A组(12.50%,5/40)(P<0.05),而A组和B组之间无明显差异(P>0.05);术后3月C组ADL1～3级患者比例(37.50%,6/16)明显低于A组(71.43%,25/35)和B组(69.05%,29/42)(P<0.05),而A组和B组之间无明显差异(P>0.05)。结论生命体征平稳的高血压基底节区出血患者,出血后6～24h手术可有效地降低患者再次出血率和死亡率,改善其预后。

Objective To explore the opportunity of CT-guided stereotaxic transcranial puncture drainage （CGSTPD） for the hypertensive basal ganglia hemorrhage and the prognoses in the patients with hypertensive cerebral hemorrhage. Methods Of 109 patients with hypertensive basal ganglia hemorrhage （volume range, 30-60 ml）, who treated by CGSTPD in our hospital from May, 2007 to October, 2010, 40 （group A） received CGSTPD 6 or within 6 hours, 44 （group B） from 6 to 24 hours and 25 （group C） from 24 to 72 hours after the hemorrhage. The prognoses were compared among three groups. Results The rates of rebleeding within 3 days after the operation in groups A, B and C were 20.00%（8/40）, 4.55%（2/44） and 0.00% respectively. The death rate in groups A, B and C were 12.50% （5/40）, 4.55% （2/44） and 36.00% （9/25） respectively. The rate of rebleeding was significantly higher in group A than those in groups B and C （P〈0.05）. The death rate of was significantly higher in group C than those in groups A and B （P〈0.05）. The rates of grades 1-3 of activity of daily living were significantly higher in groups A and B than that in group C （P〈0.05）. Conclusions It is suggested that the curative effect of CGSTPD performed 6-24 hours after the hemorrhage on hypertensive basal ganglia hemorrhage is better. If the patient＇s condition should be stable, CGSTPD would be performed 6-24 hours after the hemorrhage.