早期双通道穿刺引流术治疗高血压脑出血的临床研究

Clinical study on the treatment of hypertensive cerebral hemorrhage by early double channel drainage

目的探讨早期双通道穿刺引流术治疗基底节区高血压脑出血的手术时机。方法对117例基底节区高血压脑出血患者进行回顾性分析,治疗组59例(发病距手术时间在7~12 h),对照组58例(发病距手术时间在12~24 h);经颞部双通道穿刺引流术,比较2组患者术后再出血、呼吸道感染、泌尿系感染、消化道出血发生率,比较2组患者手术后3个月格拉斯哥预后评分(GOS)及日常生活活动能力评分(ADL),比较2组患者术前、术后1周、1个月、3个月时NIHSS评分,比较发病后24 h、48 h、72 h、96 h及1周血清中白细胞介素-6(IL-6)的水平。结果2组患者术后再出血发生率比较差异无统计学意义(P>0.05),治疗组术后呼吸道感染、泌尿系感染及消化道出血的发生率均明显低于对照组(P<0.05)。治疗组术后3个月GOS评分及ADL评分明显高于对照组(P<0.05)。治疗组术后1周、1个月、3个月时NIHSS评分低于对照组(P<0.05)。治疗组患者发病后24、48、72、96 h及1周血清中IL-6的水平均明显低于对照组,切峰值明显低于对照组(P<0.05)。结论对基底节区高血压脑出血应早期行微创钻孔引流术,手术时间窗掌握在距发病7~12 h为宜,可以尽早引流出血血肿,减轻缺血损伤及炎性损伤,且不增加术后再出血发生率,明显改善预后。

Objective To investigate the surgical opportunity of early double-channel puncture and drainage in treatment of hypertensive cerebral hemorrhage in basal ganglia.Methods The clinical data about 117 patients with hypertensive intracerebral hemorrhage in basal ganglia region were retrospectively analyzed.These patients were divided into treatment group(the time between onset and operation was from 7 hours to 12 hours,n=59)and control group(the time between onset and operation was from 12 hours to 24 hours,n=58).The incidence rates of postoperative rebleeding,respiratory tract infection and gastrointestinal bleeding were observed and compared between the two groups.Moreover the Glasgow Outcome Scale(GOS)and Activity of Daily Living Scale(ADL)were compared between the two groups after operation.And the NIHSS scores before operation,at 1w,1m,3m after operation were compared,moreover,the serum levels of interleukin-6(IL-6)at 24h,48h,72h and 1 week after onset were observed and compared between the two groups.Results There was no significant difference in the incidence rate of postoperative rebleeding between the two groups(P>0.05).The incidence rates of respiratory tract infection,urinary system infection and gastrointestinal bleeding in treatment group were significantly lower than those in control group(P<0.05).And the scores of GOS and ADL at 3m after operation in treatment group were significantly higher than those in control group(P<0.05).However the NIHSS scores at 1w,1m,3m after operation in treatment group were significantly lower than those in control group(P<0.05).In addition the serum levels of IL-6 and the cut-off peak value at 24h,48h,72h,1 week after onset in treatment group were significantly lower than those in control group(P<0.05).Conclusion The minimally invasive trepanation and drainage should be performed in the early stage of hypertensive cerebral hemorrhage in basal ganglia.The operation time window should be during 7~12h from onset,which can drain hematoma as early as possible,alleviate ischemic injury and inflammatory injury,and do not increase the incidence of rebleeding after operation,so as to improve the prognosis of patients significantly.