CT引导下微创穿刺血肿抽吸术治疗高血压性丘脑出血

CT-guided minimally invasive hematoma aspiration in the treatment of hypertensive thalamic hemorrhage

目的:探讨和总结高血压性丘脑出血在CT引导下使用微创穿刺术的治疗方法,以提高患者的治疗效果。方法:收集2004-08-2012-08期间使用的微创穿刺血肿抽吸术治疗高血压性丘脑出血82例患者的临床资料和CT影像学检查资料,分析其临床治疗过程,进一步总结出微创穿刺技术在高血压性脑出血患者中的治疗经验。结果:本组病例中,患者以偏瘫(76例)、意识障碍(64例)、偏身感觉障碍(55例)、语言障碍(47例)、发热(42例)为主要症状。根据CT影像学表现分型:Ⅰa型12例,Ⅰb型例20例,Ⅱa型17例,Ⅱb型25例,Ⅲ型8例。结合CT计算出血量10ml≤V<30ml45例,V≥30ml37例。全部病例均在CT引导下行微创穿刺血肿抽吸术,其中死亡10例(12.2%),存活者术后三月内复查随访,经ADL(ActivityofDailyLiving)日常生活活动分级:Ⅰ级(恢复社会活动)12例(14.6%)、Ⅱ级(恢复家庭活动)21例(25.6%)、Ⅲ级(生活需照顾,辅助行走)30例(36.6%)、Ⅳ级(长期卧床)9例(11.0%)。结论:CT引导微创穿刺血肿抽吸术治疗高血压性丘脑出血微创、快速,临床具有明显的治疗效果。

Objective：To explore and summarize the treatment of hypertensive thalamic hemorrhage using CTguided minimally invasive puncture.Method：82patients ＇ clinical data and CT imaging data in eight years were collected.Minimally invasive puncture for hypertensive thalamic hemorrhage was applied in all patients and the clinical course of treatments were analyzed.The treatment experiences of minimally invasive puncture technique in hypertensive thalamic hemorrhage were further summarized.Result：In this group,the main symptoms included hemiplegia（76cases）,disturbance of consciousness（64cases）,hemisensory disorder（55cases）,language barriers（47cases）,fever（42cases）.There were typeⅠa 12cases,typeⅠb 20cases,typeⅡa 17cases,Ⅱb 25cases,typeⅢ 8 cases according to the CT findings.The amount of bleeding was calculated combined with CT,10ml≤V30ml 45cases,V≥30ml 37cases.All patients were treated with CT guided minimally invasive hematoma stereotactic aspiration.In this group,10patients died.These survives were followed up in three months and assessed the activities of daily living grading with ADL,gradeⅠ（restore social activities） 12cases（14.60%）,gradeⅡ（restore family activities） 21cases（25.6%）,gradeⅢ（living and walking with aids） 30cases（36.6%）,gradeⅣ（bedridden） 9cases（11.0%）.Conclusion：CT-guided minimally invasive stereotactic aspiration in the treatment of hypertensive thalamic hemorrhage has minimally invasive and rapid effect,and has significant clinical effects.