颅内血肿微创抽吸引流术联合rt-PA治疗自发性脑出血疗效及对患者神经功能和并发症的影响

Clinical Effects of Minimally Invasive Intracranial Hematoma Aspiration and Drainage Combined with Rt-PA in the Treatment of Spontaneous Intra-Cerebral Hemorrhage and the Influence on Neurological Function and Complications

目的:探讨颅内血肿微创抽吸引流术(微创术)联合重组组织型纤溶酶原激活剂(rt-PA)治疗自发性脑出血疗效及对患者神经功能和并发症的影响。方法:回顾性选取2016年5月至2019年5月在本院接受治疗的自发性脑出血患者146例,按照治疗方法的不同分为对照组(n=72例)和观察组(n=74例),对照组给予传统的开颅手术治疗,观察组给予微创术联合rt-PA治疗,比较两组患者的手术相关指标、临床疗效、神经功能及并发症的发生情况。结果:观察组手术时间、住院时间明显短于对照组(P<0.05),两组患者于术前、术后1d和术后7d血肿体积比较具有统计学意义(P<0.05),术后不同时间点,两组患者血肿体积均有不同程度减少,不过,术后1d观察组的血肿体积大于对照组(P<0.05),术后7d两组的血肿体积无明显差异(P>0.05);随访期间无患者死亡,观察组患者GOS良好率为67.57%显著高于对照组50.00%(P<0.05);两组患者治疗前的NIHSS评分、SSS评分无明显差异(P>0.05),治疗后两组患者的上述评分均降低,观察组评分显著低于对照组,且治疗前后差值高于对照组(P<0.05);观察组患者的再出血率、血脑屏障指数显著低于对照组(P<0.05),两组患者颅内感染发生率无明显差异(P>0.05)。结论:采用微创术联合rt-PA治疗自发性脑出血患者,手术创伤小,术后恢复快,临床疗效较好,有助于脑神经功能的恢复,减少对脑神经功能的损伤,并发症发生率低。

Objective:To investigate the clinical effects of minimally invasive intracranial hematoma aspiration and drainage combined with recombinant tissue-type plasminogen activator(rt-PA)in the treatment of spontaneous intracerebral hemorrhage and the influence on neurological function and complications.Methods:This study retrospectively reviewed 146 patients with spontaneous intracerebral hemorrhage treated in the hospital between May 2016 and May 2019.Patients treated with conventional craniotomy were included in the control group(72 cases)and those treated with minimally invasive intracranial hematoma aspiration and drainage combined with rt-PA were included in the observation group(74 cases).The two groups were compared in terms of operation-related indexes,clinical effects,neurological function and complications.Results:The observation group had significantly shorter operation time and hospital stay than the control group(P<0.05).The comparison of hematoma volume between the two groups before operation,at 1 d and 7 d after operation showed statistically significant differences(P<0.05).The hematoma volume of the two groups decreased at different time points after operation,and the observation group had larger hematoma volume than the control group at 1 day after operation(P<0.05),but no significant difference was observed in hematoma volume between the two groups at 7 days after operation(P<0.05).No patient died during the follow-up period.The excellent and good rate of GOS was 67.57%in the observation group,and 50.00%in the control group(P>0.05).Before treatment,no significant differences were found between the two groups in NIHSS scores and SSS scores(P>0.05).After treatment,the above scores decreased in both groups,and the observation group had significantly lower scores than the control group.In addition,the difference values before and after treatment were higher in the observation group than in the control group(P<0.05).The rebleeding rate and blood-brain barrier index were significantly lower in the observation group than in the control group(P<0.05).There was no significant difference in the incidence of intracranial infection between the two groups(P>0.05).Conclusion:Minimally invasive intracranial hematoma aspiration and drainage combined with rt-PA for treating spontaneous intracerebral hemorrhage has characteristics of less surgical trauma,fast postoperative recovery,and good clinical effects.It is conductive the recovery of cranial nerve function and reduction of damage to the cranial nerve,with a low incidence of complications.