立体定向手术治疗基底核区高血压性脑出血手术时机的探讨

Clinical Research on Time Window of Stereotactic Surgery for Basal Ganglia Hypertensive Cerebral Hemorrhage

目的探讨立体定向血肿抽吸置管引流术治疗基底核区高血压性脑出血的手术时机。方法 2003年1月~2016年1月我科采用立体定向手术治疗基底核区高血压脑出血135例,根据发病后手术时间不同分为超早期组(≤7 h)45例,早期组(7~24 h)45例,延期组(24~72 h)45例,比较3组术后血肿清除时间,30 d病死率,30 d患侧肢体运动功能和90 d格拉斯哥结果评分(Glasgow outcome score,GOS)。结果超早期组与早期组比较,超早期组血肿清除时间短[(4.5±0.8)d vs.(4.9±1.0)d,q=2.860,P<0.05],术后30 d患肢肌力4~5级优于早期组[82.2%(37/45)vs.62.2%(28/45),Z=-5.572,P=0.000],90 d GOS 5分者优于早期组[88.9%(40/45)vs.71.1%(32/45),Z=-6.836,P=0.035]。超早期组与延期组比较,超早期组血肿清除时间短[(4.5±0.8)d vs.(5.3±1.0)d,q=5.721,P<0.05],术后30 d患肢肌力4~5级者优于延期组[82.2%(37/45)vs.40.0%(18/45),Z=-5.566,P=0.000],90 d GOS 5分者优于延期组[88.9%(40/45)vs.48.9%(22/45),Z=-6.771,P=0.000]。早期组与延期组比较,早期组血肿清除时间短[(4.9±1.0)d vs.(5.3±1.0)d,q=2.860,P<0.05],治疗30 d患肢肌力4~5级者优于延期组[62.2%(28/45)vs.40.0%(18/45),Z=-2.073,P=0.038],90 d GOS 5分者优于延期组[71.1%(32/45)vs.48.9%(22/45),Z=-3.595,P=0.000]。结论立体定向手术治疗基底核区高血压性脑出血最佳手术时机在7 h内。

Objective To investigate the clinical efficacy of stereotactic surgery for basal ganglia hypertensive cebral hemorrhage at different time windows. Methods According to the time window of surgery,a total of 135 patients with basal gannglia hypertensive cebral hemorrhage were divided into three groups,including ultra-early group（ n = 45,surgery started within 7h）,early group（ n = 45,surgery started between 7-24 h）,and delayed group（ n = 45,surgery started between 24-72 h）. The differences in the hematoma clearance time,the 30-day mortality rate and motor function of the paralytic limbs,and the 90-day Glasgow outcome scores（ GOS） were compared among the three groups. Results As compared to the early group,the ultra-early group had shorter hematoma clearance time [（ 4. 5 ± 0. 8） d vs.（ 4. 9 ± 1. 0） d,q = 2. 860,P〈0. 05],higher rate of diseased limb muscle of grade 4-5 on the 30 th day [82. 2%（ 37/45） vs. 62. 2%（ 28/45）,Z =-5. 572,P = 0. 000],and higher rate of GOS scores of 5points on the 90 th day [88. 9%（ 40/45） vs. 71. 1%（ 32/45）,Z =-6. 836,P = 0. 035]. As compared to the delayed group,the ultra-early group had shorter hematoma clearance time [（ 4. 5 ± 0. 8） d vs.（ 5. 3 ± 1. 0） d,q = 5. 721,P〈0. 05 ],higher rate of diseased limb muscle of grade 4-5 on the 30 th day [82. 2%（ 37/45） vs. 40. 0%（ 18/45）,Z =-5. 566,P = 0. 000],and higher rate of GOS scores of 5 points on the 90 th day [88. 9%（ 40/45） vs. 48. 9%（ 22/45）,Z =-6. 771,P = 0. 000]. As compared to the delayed group,the early group had shorter hematoma clearance time [（ 4. 9 ± 1. 0） d vs.（ 5. 3 ± 1. 0） d,q = 2. 860,P〈0. 05],higher rate of diseased limb muscle of grade 4-5 on the 30 th day [62. 2%（ 28/45） vs. 40. 0%（ 18/45）,Z =-2. 073,P =0. 038],and higher rate of GOS scores of 5 points on the 90 th day [71. 1%（ 32/45） vs. 48. 9%（ 22/45）,Z =-3. 595,P =0. 000]. Conclusion The optimal timing of stereotactic surgery for basal ganglia hypertensive cerebral hemorrhage is within 7hours.