脑出血立体定向微创引流术后血肿腔冲洗的临床效果

Clinical Study on Different Hematoma Cavity Washing Methods after Minimally Invasive Surgery in Intracerebral Hemorrhage Patients

目的：探讨自发性脑出血患者立体定向微创血肿引流术后生理盐水血肿腔冲洗对血肿清除率、拔针时间及神经功能评分的影响。方法：72例基底节区脑出血（20～40）mL患者，在发病后6～24h给予立体定向微创硬通道颅内血肿穿刺引流术，37例术后给予生理盐水血肿腔冲洗及血肿溶解剂的患者作为观察组，35例给予血肿溶解剂的患者为对照组。比较两组在术后第3天血肿清除率、拔针时间、拔针前残余血肿量、术后2周时的神经功能评分及住院期间并发症。结果：观察组拔针时间长于对照组，差异有统计学意义（P〈0．05）；两组术后第3天时血肿清除率、拔针前残余血肿量、术后2周时的NIHSS神经功能评分及并发症发生率比较，差异无统计学意义（P〉0．05）。结论：基底节区中等量（20—40mL）脑出血血肿引流术后患者，给与生理盐水血肿腔冲洗可使拔针时间延长，不宜行生理盐水血肿腔冲洗。

Objective： To investigate the influence of washing hematoma cavity with physiological sa- line on hematoma removal rate, removal time of puncture needle and neurological function score after stereotaxic minimally invasive hematoma evacuation in spontaneous intracerebral hemorrhage patients. Methods： 72 spontaneous cerebral hemorrhage in basal ganglia region patients with amount of bleeding between 20 - 40 mL, every patients were performed stereotaxic minimally invasive hematoma evacua- tion surgery between 6 - 24 h after onset. 37 of them were performed hematoma cavity washing by physiological saline and infusion of urokinase, then defined as Observation group; 35 as control grou were given urokinase in hematoma caving only. for both groups, puncture needle removal time, Comparing hematoma clearance rate 3 d after operation neurological function score after 2 w of operation, and complication rate during hospitalization. Result： Puncture needle removal time was （5. 176± 1. 770 5） d and （4. 294±1. 567 3 ） d respectively in observation group and control group respectively, differ- ence was statistically significant （P 〈 0.05） ; with regard to hematoma clearance rate 3 d after opera- tion, hematoma volume before puncture needle remove pull out , neurological function score after 2 w of operation, complication rate during hospitalization, there was no difference between two group （P 〉 0.05 ）. Conclusion： Washing hematoma caving with physiological saline have delayed removal time ofpuncture needle in spontaneous basal ganglia region cerebral hemorrhage with amount of bleeding be- tween 20 -40 mL, therefore this approach is not recommended.