中等量基底核区脑出血两种早期干预方案的对比

Comparison of two early surgical interventions for moderate basal ganglia hemorrhage

目的探讨中等量基底核区出血病人早期采用神经导航辅助下血肿穿刺抽吸联合尿激酶溶栓的优越性。方法回顾性分析64例出血量在20~40 ml基底核区出血病人的临床资料,按手术方法不同分为两组,观察组采用神经导航辅助下血肿穿刺抽吸联合尿激酶溶栓治疗,对照组采用显微镜下微骨窗颞中回或外侧裂入路手术。对比两组治疗结果。结果血肿清除率比较:术后1 d观察组明显低于对照组(P<0.05),而术后5 d两组无明显差异(P>0.05)。水肿带体积比较:术后1 d两组无明显差异(P>0.05),术后5、10 d观察组比对照组明显减小(P<0.05)。术后3周内并发症比较:观察组并发症发生率明显低于对照组(P<0.05)。术后3个月ADL评分比较:两组无显著差异(P>0.05)。结论早期神经导航辅助下血肿穿刺抽吸联合尿激酶治疗中等量基底核区出血能减轻血肿周围水肿带,降低术后早期并发症,使病人更早进入康复阶段。

Objective To explore the advantages of neuronavigation-assisted aspiration combined with urokinase thrombolysis in the early stage for moderate basal ganglia hemorrhage.Methods Clinical data of 64 patients with basal ganglia hemorrhage of 20 to 40 ml were analyzed retrospectively,and the patients were divided into two groups according to the different surgeries.The observation group was treated with hematoma aspiration combined with urokinase thrombolysis with the assistance of neruonavigation,and the control group was treated with small bone window and medial temporal gyrus or lateral fissure approach under microscope.Then,the treatment results were compared between the two groups.Results The hematoma evacuation rate of observation group was obviously lower than the control group 1 d after the operation(P<0.05),but there were no significant differences on 5 d after the operation(P>0.05).The edema volume of observation group was obviously lower than that of control group on 5,10 d after the surgery(P<0.05),but there was no significant difference on 1 d(P<0.05).The complication rate within 3 weeks after the operation in the observation group was obviously lower than the control group(P<0.05).There was no significant difference in the ADL score after 3 months between the two groups(P>0.05).Conclusion Hematoma aspiration combined with urokinase thrombolysis with the assistance of neruonavigation in the early stage can reduce the edema volume and postoperative complications,and enter the recovery stage earlier for patients with moderate basal ganglia hemorrhage.