CT引导下颅内血肿微创清除术治疗高血压性脑出血临床分析

Clinical analysis of CT-guided micro-traumatic operation for intracranial hematoma in treatment of hypertensive intracerebral hemorrhage

目的探讨在CT引导下颅内血肿微创清除术治疗高血压性脑出血的临床疗效。方法选择2009年1月至2010年12月在该科住院且明确诊断为脑出血患者80例,随机分为微创组和常规组,各40例。微创组患者在CT定位下运用YL-1型颅内粉碎穿刺针行血肿清除术,常规组患者仅采用常规治疗。比较分析两组患者好转率、病死率及死亡原因,对两组存活患者术后3个月采用日常生活能力量表(ADL)和Barthel指数评分评定致残率。结果微创组存活率(85.0%)明显高于常规组(60.0%),病死率(15.0%)明显低于常规组(40.0%),且致残率(14.7%)较常规组(41.7%)明显下降,差异均有统计学意义(χ2=5.234、6.270、4.417,P=0.022、0.012、0.036)。两组患者死亡原因主要为发生脑疝,共7例(微创组3例、常规组4例)。结论 CT引导下的颅内血肿微创清除术是治疗高血压性脑出血的一种有效手段,具有创伤小、对手术环境要求低的特点,适宜在基层医院开展应用,可降低脑出血的病死率和致残率,提高存活患者的日常生活能力。

Objective To approach the clinical efficacy of CT-guided micro-traumatic operation for intracranial hematoma in treatment of hypertensive cerebral hemorrhage. Methods A total of 80 patients diagnosed with intracerebral hemorrhage in this hospital received from Jan. 2009 to Dee. 2010 were selected and divided into the miero-invasive group and the normal-care group, 40 cases in each group. The patients in the miero-invasive group were operated with mieroinvasive surgery by YL-1 intraeranial smash needle under CT-positioning hematoma（MTG） while the patients in the normal-care group with the conventional therapy. A comparative analysis of the improvement rate, mortality and morbidity as well as cause of death of the two groups was conducted. A disability rate was assessed for the survivals according to ADL and Barthel indicators after postoperative 3 months. Results The survival rate （85.0%） of the micro-invasive group was significantly higher than that （60.0%） of the normal-care group. The mortality（ 15% ） of the miero-invasive group was lower than that （40.0%）of the normal-care group with statical significance （Х^2=5.234,6.270,4.417, P=0.022,0.012,0.036 ）. The causes of death in the both groups mainly were the relapsing hemorrhage（7 cases in total including 3 from the micro-invasive group and 4 from the normal-care group）. Conclusion CT-guided micro-traumatic operation for intracranial hematoma is an effective mean of treating hypertensive intraeerebral hemorrhage, being characterized with less trauma, and low demand to the surgical environment,which is suitable for grass-roots hospitals to reduce mortality and disability rates of cerebral hemorrhage morbidity and improve their activities of daily living.