CTA点征在中等量脑出血超早期手术方式选择中的应用价值分析

Value of CT angiography point sign in selecting operative methods for patients with moderate amount cerebral hemorrhage at ultra-early stage

目的探讨CT血管成像(CTA)点征在中等量基底节区出血超早期钻孔引流或开颅手术选择中的应用价值及对预后的影响。方法回顾性收集邢台市第三医院神经外科自2017年3月至2019年3月收治的126例中等量(出血量30~60 mL)基底节区出血患者的临床资料,患者经评估均可同样耐受开颅手术或钻孔引流,且家属同意超早期手术治疗并行CTA检査,其中行开颅手术68例(开颅手术组),包括CTA点征阴性者38例(阴性亚组)和阳性者30例(阳性亚组);行钻孔引流58例(钻孔引流组),包括CTA点征阴性者39例(阴性亚组)和阳性者19例(阳性亚组)。比较开颅手术组与钻孔引流组间,以及2组内CTA点征阴性亚组与阳性亚组间患者预后及术后再出血发生率的差异。结果开颅手术组和钻孔引流组患者的预后良好率、术后再出血发生率分别为61.8%、2.9%及82.8%、15.5%,差异均有统计学意义(P<0.05)。开颅手术组内CTA点征阳性亚组和阴性亚组患者的预后良好率、术后再出血发生率分别为60.0%、4.8%及63.2%、2.1%,差异均无统计学意义(P<0.05)。钻孔引流组内CTA点征阳性亚组和阴性亚组患者的预后良好率、术后再出血发生率分别为63.2%、36.8%及92.3%、5.1%,差异均有统计学意义(P<0.05)。结论在中等量基底节区出血患者中,对于CTA点征阴性者,评估为开颅手术和钻孔引流术后再出血风险均低,再考虑到钻孔引流预后优于开颅手术,建议选择钻孔引流治疗;对于CTA点征阳性者,评估为开颅手术术后再出血风险低、钻孔引流术后再出血风险高,建议选择开颅手术治疗,从而更有效地改善患者预后。

Objective To investigate the value of CT angiography(CTA)point sign in the treatment of patients with moderate amount basal ganglia hemorrhage at ultra-early stage by trephination and drainage or craniotomy,and its influence in the prognoses.Methods One hundred and twenty-six patients with moderate amount basal ganglia hemorrhage(30-60 mL)admitted to our hospital from March 2017 to March 2019 were chosen in our study;these patients were evaluated and conforaied to have the same tolerance of craniotomy or drainage;and their families agreed to the ultra-early surgical treatments;their clinical data were retrospectively collected.They all accepted CTA before operation.Among them,68 were into the craniotomy group,including 38 into CTA spot sign negative sub-group and 30 into positive sub-group;58 were into the trephination and drainage group,including 39 into CTA spot sign negative sub-group and 19 into positive sub-group.The differences of favorable prognosis rate and postoperative re-hemorrhage rate were compared between the craniotomy group and trephination and drainage group,as well as each two sub-groups.Results The favorable prognosis rate and postoperative re-hemorrhage rate of patients in the craniotomy group(61.8% and 2.9%)were significantly lower as compared with those in the trephination and drainage group(82.8% and 15.5%,P<0.05).In the craniotomy group,the favorable prognosis rate and postoperative re-hemorrhage rate in the CTA spot sign positive sub-group(60.0% and 4.8%)were higher than those in the negative sub-group(63.2% and 2.1%),without significant differences(P>0.05);in tiie trephination and drainage group,the favorable prognosis rate and postoperative re-hemorrhage rate in the CTA spot sign positive sub-group(63.2% and 36.8%)were significantly different as compared with those in the negative sub-group(92.3%and 5.1%,P<0.05).Conclusion Among patients with moderate amount basal ganglia hemorrhage,prognoses can be ejBfectively improved in the following treatments:if the patients have negative CTA spot sign,are evaluated to have low risk of postoperative re-hemorrhage after craniotomy or drainage,and are considered that the prognosis by drainage is better than that by craniotomy,trephination and drainage should be selected;if the patients have positive CTA spot sign,and are evaluated to have lower risk of postoperative re-hemorrhage by craniotomy than that by drainage,craniotomy should be selected.