经额定向穿刺引流术治疗基底节区高血压脑出血的疗效及安全性

Effect and safety of transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region

目的探讨经额定向穿刺引流术治疗基底节区高血压脑出血的临床效果及安全性。方法选择2016年1月至2017年6月汉中市中心医院收治的124例基底节区高血压脑出血患者为研究对象,根据手术方式将患者分为开颅手术组(72例)和穿刺引流组(52例)。穿刺引流组患者采用经额定向穿刺引流术治疗,开颅手术组患者采用开颅血肿清除术治疗,对2组患者的手术时间、术中出血量、术后引流量、术后并发症、首次下床活动时间、住院时间、术后1个月神经功能及术后6个月日常生活活动能力(ADL)进行比较。结果穿刺引流组患者的手术时间、首次下床活动时间、住院时间显著短于开颅手术组(t=12.038、4.375、5.113,P<0.01),穿刺引流组患者术中出血量和术后引流量显著少于开颅手术组(t=9.427、8.804,P<0.01)。术后1个月,穿刺引流组患者中国脑卒中临床神经功能缺损程度量表评分和美国国立卫生研究院卒中量表评分显著低于开颅手术组(t=6.164、6.309,P<0.01)。术后6个月,穿刺引流组和开颅手术组患者ADL良好率分别为90.4%(47/52)、68.1%(49/72),穿刺引流组患者ADL良好率显著高于开颅手术组(χ2=8.542,P<0.01)。穿刺引流组和开颅手术组患者术后并发症发生率分别为9.6%(5/52)、36.1%(26/72),穿刺引流组患者术后并发症发生率显著低于开颅手术组(χ2=11.214,P<0.01)。结论经额定向穿刺引流术治疗基底节区高血压脑出血可以缩短手术时间,减少术中出血量,有效促进患者神经功能及ADL恢复,降低术后并发症发生率。

Objective To investigate the effect and safety of transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Methods A total of 124 patients with hypertensive cerebral hemorrhage in basal ganglia in Hanzhong Central Hospital from January 2016 to June 2017 were selected as the subjects.The patients were divided into craniotomy group（n=72） and puncture drainage group（n=52） according to the operative method.The patients in the puncture-drainage group were treated with transfrontal stereotactic puncture and drainage,and the patients in the craniotomy group were treated with craniotomy and hematoma removal.The operation time,intraoperative bleeding,postoperative drainage,postoperative complications,the time of first ambulation,hospitalization time,the nerve function of one month after operation and the activities of daily living（ADL） of six months after operation were compared between the two groups.Results The operation time,the time of first ambulation and the hospitalization time in the puncture drainage group were significantly shorter than those in the craniotomy group（t=12.038,4.375,5.113;P〈0.01）.The intraoperative bleeding and postoperative drainage in the puncture drainage group were significantly less than those in the craniotomy group（t=9.427,8.804;P〈0.01）.The scores of China stroke scale and the national institute of health stroke scale in the puncture drainage group were significantly lower than those in the craniotomy group at one month after operation（t=6.164,6.309;P〈0.01）.The fineness rate of ADL in the puncture drainage group and the craniotomy group was 90.4%（47/52） and 68.1%（49/72） respectively at six months after operation,the fineness rate of ADL in the puncture drainage group was significantly higher than that in the craniotomy group（χ~2=8.542,P〈0.01）.The incidence of postoperative complications in the puncture drainage group and the craniotomy group was 9.6%（5/52） and 36.1%（26/72） respectively,the incidence of postoperative complications in the puncture drainage group was significantly lower than that in the craniotomy group（χ~2=11.214,P〈0.01）.Conclusion Transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region can shorten the operation time,reduce the intraoperative bleeding,effectively promote the recovery of neurological function and ADL,and reduce the incidence of postoperative complications.