CT定位下微创穿刺治疗高血压基底节区脑出血短期疗效分析

Short-term curative effect of CT-guided minimally invasive puncture on hemorrhage in basal ganglia of elderly hypertensive patients

目的探讨CT定位下微创穿刺血肿清除术治疗老年高血压基底节区脑出血的短期临床疗效及影响因素。方法回顾性分析82例微创穿刺血肿清除术（微创组）患者和46例常规开颅血肿清除术（常规组）患者术前格拉斯哥昏迷评分（GCS）、血肿量、有无脑疝、有无急性脑积水、手术时机和术后1个月GCS和生存情况。比较2组患者病死率和术后1个月GCS及影响微创组患者短期疗效的影响因素。结果微创组与常规组短期病死率比较，差异无统计学意义（26．8％us15．2％，P=0．132）。微创组术后GCS改善程度明显高于常规组（P=0．002）。手术时机和术前GCS是影响微创穿刺血肿清除术短期疗效的主要因素（OR=4．140，95％CI：1．153～14．862，P=0．029；OR=5．199，95％CI：1．109～24．386，P=0．037）。结论CT定位下微创穿刺血肿清除术治疗老年高血压基底节区脑出血短期疗效确切，早期行微创穿刺血肿清除术可显著改善患者短期预后。

Objective To study the short-term curative effect of CT-guided minimally invasive puncture on hemorrhage in basal ganglia of elderly hypertensive patients and its influencing fac- tors. Methods Eighty-two elderly hypertensive patients who underwent CT-guided minimally in- vasive puncture for evacuation of hematoma served as a minimally invasive operation group and 46 elderly hypertensive patients who underwent routine craniotomy for evacuation of hematoma served as a routine operation group in this study. Their clinical data were retrospectively ana- lyzed, including gender, age,Glasgow coma scale （GCS） score, hematoma volume, cerebral hernia, acute hydrocephalus, operation time, postoperative 1 month GCS score, and survival time. The mortality,postoperative 1 month GCS score,and factors influencing the short-term curative effect were compared. Results No significant difference was found in mortality between the two groups （26.8% vs 15.2% ,P=0. 132）. The postoperative 1 month GCS score was significantly higher in minimally invasive operation group than in routine operation group （P=0. 002）. Operation time and preoperative GCS score were the major factors influencing the short-term curative effect of CT-guided minimally invasive puncture for evacuation of hematoma in elderly hyper tients （OR=4. 140,95%CI：1. 153-14. 862,P=0. 029,OR=5. 199,95%CI： 1. 109-2 0. 037）. Conclusion The short-term curative effect of CT-guided minimally invasive good on ture for evacuation evacuation tenslve pa- 4. 386,P= puncture is of hematoma in elderly hypertensive patients. Early minimally invasive punc of hematoma can significantly improve their prognosis.