不同时间窗行CT定向穿刺术治疗高血压基底核区出血的临床研究

Clinical Research on Treating Hypertensive Basal Ganglia Hemorrhage with CT Stereotactic Aspiration at Different Time Windows

目的探讨不同时间窗行CT定向穿刺术治疗高血压基底核区出血的作用机制及临床疗效。方法选择基底核区高血压脑出血（HIH）患者112例，根据发病至手术的间隔时间进行分组，分为超早期组（n=35）、早期组（n=39）、延迟组（n=38），超早期组、早期组、延迟组分别于出血后〈7h、7-24h、〉24h实施手术，观察3组患者出血后24、72、120、168h静脉血IL-6、TNF-α含量变化及术后并发症发生情况、3个月内临床疗效。结果超早期组患者出血后72、120、168h时血清IL-6、TNF-α均明显低于早期组、延迟组（P〈0．05）。早期组在72、120、168h时血清IL-6、TNF-α均明显低于延迟组（P〈0．05）。超早期组肺部感染、应激性溃疡、肾衰竭发生率明显低于早期组、延迟组（P〈0．05）。早期组肺部感染、应激性溃疡、肾衰竭发生率明显低于延迟组（P〈0．05）。超早期组恢复良好率明显高于早期组、延迟组（P〈0。05），早期组恢复良好率明显高于延迟组（P〈0．05）。超早期组轻度残疾率、重度残疾率均明显低于早期组、延迟组（P〈0．05），早期组重度残疾率均明显低于延迟组（P〈0．05）。超早期组、早期组病死率明显低于延迟组（P〈0．05）。结论对HIH患者应尽早（〈7h）进行CT定向穿刺清除血肿术，可减少IL-6、TNF-α等炎症因子的增加，降低并发症的发生，提高临床疗效，是值得临床借鉴的一种方法。

Objective To investigate the clinical effect and mechanism of treating hypertensive basal ganglia hemorrhage with CT stereotactic aspiration at different time windows. Methods Totally 112 cases of patients with basal ganglia HIH were selected and divided into ultra - early group（ n = 35 ）, early group （n = 39） , delayed group （n = 38 ） according to the time from bleeding to operation. The pa- tients of ultra - early group, early group, delaye group were carried out operation at 〈 7h,7 -24h, 〉 24h after bleeding. The serum IL - 6, TNF-α level changes at 24h, 72h, 120h, 168h after bleeding and postoperative complication,and clinical effect at postoperative 3 months were observed. Results The serum IL - 6, TNF - α level at 72h, 120h, 168h after bleeding of ultra - early group were signifi- cantly lower than those of early group or delayed group （ P 〈 O. 05 ）. The serum IL - 6, TNF - α level at 72h, 120h, 168h after bleeding of early group were significantly lower than those of delayed group （ P 〈 0.05 ）. The incidence of lung infection, renal failure, stress ulcer in ultra - early group were significantly lower than those in early group or in delay group （P 〈 0.05 ）. The incidence of lung infection, re- nal failure, stress ulcer in early group were significantly lower than those in delay group （P 〈 0.05 ）. The good recovery rate of ultra - ear- ly group was significantly higher than that of early group or delayed group （P 〈 0.05）. The good recovery rate of early group was signifi- cantly higher than that of delay group（ P 〈 0.05 ）. The mild disability, severe disability rate of ultra - early group were significantly lower than that of early group or delay group （P 〈 0.05）. The severe disability rate of early group was significantly lower than that of delay group （P 〈 0.05）. The death rate of ultra - early group or early group was significantly lower than that of in delay group （ P 〈 0.05 ）.Conclusion Treating HIH patients with CT stereotactic aspiration at 〈7h after bleeding can reduce inflammatory factors such as IL - 6, TNF - α, reduce complication, improve clinical effect. It is a method which is worthy of clinical reference.