微创治疗高血压性脑出血对皮质脊髓束及预后的影响

Effect of minimally invasive treatment for hypertensive intracerebral hemorrhage on corticospinal tract hemorrhage and prognosis

目的微创治疗高血压性脑出血对皮质脊髓束及预后的影响。方法将62例高血压性脑出血患者分为观察组31例和对照组31例,对照组给予常规药物治疗,观察组行立体定向下钻孔引流术,分别于入院时、治疗3个月后进行磁共振弥散张量成像(DTI)检查,对两组患者神经功能改善情况进行评定,计算患侧/对侧的部分各向异性(FA)值。结果两组皮质脊髓束4级患者治疗3个月后FA值比较,差异无统计学意义(t=1.35,P>0.05),但观察组皮质脊髓束1~3级患者治疗3个月后FA值高于对照组,差异有统计学意义(t=2.05,P<0.05)。两组入院时美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(t=1.01,P>0.05),观察组治疗3个月后NIHSS评分低于对照组,差异有统计学意义(t=12.24,P<0.05)。结论微创手术治疗高血压性脑出血的临床疗效较保守治疗更有优势,尤其是皮质脊髓束1~3级患者早期采取微创手术治疗的预后较好。

Objective To investigate the effect of minimally invasive treatment for hypertensive intracerebral hemorrhage on eorticospinal tract hemorrhage and prognosis. Methods A total of 62 cases of patients with hypertensive intraeerebral hemorrhage were divided into the observation group and control group with 31 eases in each. The control group was given routine drug treatment, and the observation group underwent stereotaetie drainage borehole. The magnetic resonance diffusion tensor imaging （DTI） examination were performed to evaluate neurological function of two groups at hospitalized, 3 months after the treatment. And the ipsilateral / eontralateral FA value was calculated. Results The FA value of CST4 patients of two groups at 3 months after the treatment was not significant different （t=1.35,P〉0.05）. But the value of FA of the observation group with grade CST 1 to 3 was higher than the control group at 3 months after the treatment （t=2.05,P〈0.05）. The NIHSS score at hospitalized between two groups was not significant different（t=1.01 ,P〉0.05）. The NIHSS score of observation group at 3 months after the treatment was significantly lower than that of the control group （t=12.24,P〈0.05）. Conclusion The clinical curative effect of minimally invasive surgery in the treatment of hypertensive intraeerebral hemorrhage has more advantages than the conservative treatment,especially for CST 1 to 3 patients with better prognosis.