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自发性脑桥出血微侵袭手术的疗效观察与再思考

Clinical efficacy observation and reconsideration of spontaneous hypertension pontine hemorrhage via microsurgery
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摘要 目的 探讨置管引流联合尿激酶溶栓术治疗自发性脑桥出血的疗效与经验.方法 回顾性收集解放军联勤保障部队第九〇〇医院神经外科自2014年1月至2018年12月经手术治疗的42例自发性脑桥出血患者的临床资料,其中18例对照组患者行开颅血肿清除术治疗,24例观察组患者行神经导航定向辅助下置管引流联合尿激酶溶栓术治疗,对比分析2组的临床疗效差异.结果 42例患者中血肿清除率≥50%者共24例,其中对照组7例,观察组17例;观察组的血肿清除有效率(70.83%)明显高于对照组(38.89%),差异有统计学意义(P<0.05);观察组术后Glasgow-Pittsburgh昏迷评分[(24.21±4.85)分]较对照组[(23.61±5.45)分]略高,总体死亡+重残率(66.67%)较对照组(72.22%)略低,但差异均无统计学意义(P>0.05).结论 在自发性脑桥出血的手术治疗中,置管引流联合尿激酶溶栓术可有效提高血肿清除率,但因受众多因素影响,其临床预后并未明显提升. Objective To explore the efficacy and experience of surgical approaches of puncture drainage and urokinase thrombolysis for spontaneous hypertensive pontine hemorrhage. Methods The clinical data of 42 patients with spontaneous pontine hemorrhage, admitted to our hospital from January 2014 to December 2018, were retrospectively analyzed. Craniotomy evacuation of hematoma was performed in 18 patients (control group), and puncture drainage and urokinase thrombolysis assisted by neuronavigation was performed in 24 patients (observation group). The clinical efficacies of the two groups were observed and analyzed. Results There were 24 patients having hematoma clearance rate≥50%, including 7 from control group and 17 from observation group. The hematoma clearance rate≥50% in the observation group (70.83%) was significantly higher than that in the control group (38.89%, P<0.05). Postoperative Glasgow-Pittsburgh scale scores of the observation group (24.21±4.85) were slightly higher than those of the control group (23.61±5.45), and the mortality of the observation group (66.67%) was lower than that of the control group (72.22%) without statistical significance (P> 0.05). Conclusion The surgical approach of puncture drainage and urokinase thrombolysis can effectively improve hematoma clearance rate for spontaneous hypertensive pontine hemorrhage, but clinical prognoses are not improved due to influence of multiple factors.
作者 张尚明 尚明超 赵琳 魏梁锋 袁邦清 王守森 Zhang Shangming;Shang Mingchao;Zhao Lin;Wei Liangfeng;Yuan Bangqing;Wang Shousen(Department of Neurosurgery,900th Hospital of People Liberation Army,Fuzhou 350025,China)
出处 《中华神经医学杂志》 CAS CSCD 北大核心 2019年第10期996-1000,共5页 Chinese Journal of Neuromedicine
关键词 自发性脑桥出血 置管引流联合尿激酶溶栓术 开颅血肿清除术 Spontaneous pontine hemorrhage Puncture drainage and urokinase thrombolysis Craniotomy evacuation of hematoma
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