神经导航定向穿刺治疗高血压性基底节区脑出血疗效分析

Treatment of hypertensive basal ganglia hemorrhage by neuronavigationguided minimally invasive surgery with soft passage drainage

目的探讨神经导航定向穿刺术对高血压性基底节区脑出血的治疗效果及安全性。方法 2010年1月至2014年6月选取复旦大学附属金山医院符合纳入标准的患者62例,随机分成导航穿刺组和传统手术组进行血肿清除治疗。采用格拉斯哥昏迷评分(GCS)及斯坎迪纳维亚神经卒中量表(SSS)对患者术前神经功能评分,采用格拉斯哥预后量表(GOS)、SSS量表以及Barthel指数评定量表(BI)作为患者术后的随访量表,评估神经功能康复情况。结果两组患者在基线比较上无差别,术后1周SSS评分差异无统计学意义(P=0.133),1个月后SSS评分差异有统计学意义(P=0.030),而GOS评分(P=0.212)和BI(P=0.095)差异无统计学意义;6个月后SSS(P=0.027)、GOS(P=0.019)以及BI评分(P=0.006)评分差异均有统计学意义。在复发出血及肺部感染并发症的发生率方面,两组差异无统计学意义。结论神经导航定向穿刺治疗基底节区脑出血具有易操作性、安全性、患者术后恢复迅速等特点,而且在患者神经功能恢复及提高生存质量方面存在一定优势。

Objective To evaluate the efficacy and safety of neuronavigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. Methods A total of 62 patients with hypertensive basal ganglia hemorrhage,admitted to our hospital from January 2010 to June 2014,were randomly divided into two groups,neuronavigation-guided minimally invasive surgery as the experimental group and the traditional craniotomy as the control group.The preoperative neurological status was evaluated by Glasgow Coma Scale （GCS） and Scandinavian Stroke Scale （SSS）,and the postoperative neurological function was determined by Glasgow Outcome Scale （GOS）,SSS and Barthel Index （BI）. Results There were no significant difference on baseline and the neurological function represented by SSS one week after surgery （P=0.133） between two groups.One month after the surgery,the SSS score was significantly improved on the experimental group （P=0.030）,while the GOS and BI scores had no significantly difference （respectively,P=0.212 and 0.095）.However,six months after the surgery,the SSS,GOS and BI scores on the experimental group were all significantly improved （respectively,P=0.027,0.019 and 0.006） as compared to those of control group.There was no significant difference on the complications such as the rebleeding and pneumonia between two groups. Conclusions The neuronavigation-guided minimally invasive surgery is an effective and safe technique to evacuate the hematoma,and can promptly improve the prognosis and quality of life of the patients with hypertensive basal ganglia hemorrhage.