微创介入治疗高血压脑出血的临床研究

Clinical study of minimally invasive interventional therapy for hypertensive intracerebral hemorrhage

目的探讨微创介入治疗高血压脑出血的手术方法、机理以及围手术期处理。方法将我院2016年3月至2021年2月行微创介入手术治疗的158例高血压脑出血患者设为观察组,小骨窗开颅手术治疗的138例高血压脑出血患者设为对照组。观察两组患者的手术时机分布情况、血肿清除率、死亡率以及手术疗效。结果观察组超早期手术(≤6 h)37例,早期手术(7~24 h)121例;血肿清除率>80%34例,均术后第2天拔除引流管;血肿清除率在50%~80%124例,应用尿激酶2~4 d后再次复查颅脑CT提示血肿清除率>80%;微创穿刺血肿扩大转开颅手术7例,占4.43%。对照组超早期手术(≤6 h)58例,早期手术(7~24 h)80例;术后血肿清除率皆>90%。术后3个月随访,观察组死亡17例,死亡率为10.76%;对照组死亡19例,死亡率为13.77%。观察组的手术效果良好占比为75.32%(119/158),高于对照组的63.77%(88/138)(P<0.05)。结论与小骨窗开颅手术治疗相比,微创介入治疗高血压脑出血根据CT片进行三维定向划线确定穿刺靶点,引流管材质柔软,可减少脑组织的损伤,降低患者死亡率,且手术操作简单,适宜在基层医院大力推广。

Objective To explore the operation method,mechanism and perioperative management of minimally invasive interventional therapy for hypertensive intracerebral hemorrhage.Methods From March 2016 to February 2021,158 patients with hypertensive intracerebral hemorrhage treated by minimally invasive interventional surgery were set as observation group,and 138 patients with hypertensive intracerebral hemorrhage treated by small bone window craniotomy were set as control group.The operation time distribution,hematoma clearance rate,mortality and operation effect of the two groups were observed.Results In the observation group,37 cases underwent ultra-early operation(≤6 h)and 121 cases underwent early operation(7-24 h);the hematoma clearance rate was more than 80%in 34 cases,and the drainage tube was removed on the second day after operation;the clearance rate of hematoma was 50%-80%in 124 cases,and the reexaminaton of brain CT showed that the clearance rate of hematoma was more than 80%after 2-4 d of urokinase application;minimally invasive puncture hematoma expansion was transferred to craniotomy in 7 cases(4.43%).In the control group,58 cases underwent ultra-early operation(≤6 h)and 80 cases underwent early operation(7-24 h);the hematoma clearance rate after surgery was more than 90%in all patients.After 3 months follow-up,17 cases died in the observation group,the mortality was 10.76%;19 cases died in the control group,and the mortality was 13.77%.The proportion of good surgical effect in the observation group was 75.32%(119/158),which was higher than 63.77%(88/138)in the control group(P<0.05).Conclusion Compared with small bone window craniotomy,minimally invasive interventional therapy for hypertensive intracerebral hemorrhage can determine the puncture target by three-dimensional directional marking according to CT film,with soft material drainage tube,it can reduce the damage of brain tissue and the mortality of patients,and has simple surgery operation,so which is suitable for promotion in primary hospitals.