自发性基底节区不同部位出血对神经内镜手术治疗预后的影响

Effect of spontaneous basal ganglia hemorrhage in different sites on the prognosis after neuroendoscopic surgery

目的探讨自发性基底节区不同部位出血对神经内镜手术治疗预后的影响。方法回顾性分析2018-09—2020-12芜湖市第一人民医院收治的98例自发性基底节区出血患者的临床资料,根据出血部位不同分为前部型7例,内侧型9例,后内侧型11例,外侧型17例,后外侧型35例,混合型19例。观察6组患者手术时间,术前及术后1 d、3 d、7 d颅内压变化,美国国立卫生研究院卒中量表(NIHSS)评分,以格拉斯哥结局量表(GOS)评价患者预后效果。结果基底节区不同出血部位患者手术时间、血肿清除率、术中失血量、住院时间差异有统计学意义(F=13.180、5.930、214.120、5.110,P<0.05);基底节区不同出血部位患者手术前后各时间点颅内压组间差异有统计学意义(F=83.100、73.840、111.690、146.820、278.990、121.560,P<0.05);术后3 d、7 d基底节区不同部位出血患者颅内压变化差异有统计学意义(F=4.390、6.870,P<0.05);基底节区不同出血部位患者术后NIHSS量表评分较前明显降低(t=8.640、8.902、8.907、9.686、12.802、12.624,P<0.05);术后基底节区不同部位出血患者NIHSS评分比较差异有统计学意义(F=0.280、5.400,P<0.05);基底节区不同出血部位患者预后良好率(前部型85.7%,内侧型66.7%,后内侧型72.7%,外侧型47.1%,后外侧型31.4%,混合型15.8%)差异有统计学意义(χ2=19.014,P<0.05)。结论自发性基底节区不同部位出血可影响神经内镜手术时间、血肿清除率、住院时间及术后颅内压、神经功能状态。

Objective To investigate the effect of spontaneous bleeding from different parts of basal gan⁃glia on the prognosis of patients with endoscopic neurosurgery.Methods A retrospective analysis was performed on 98 patients with spontaneous basal ganglia hemorrhage admitted to our hospital from September 2018 to Decem⁃ber 2020.According to different bleeding sites,the patients were classified into anterior type(n=7),medial type(n=9),posteromedial type(n=11),lateral type(n=17),posterolateral type(n=35),and mixed type(n=19).The perioperative indicators including operation time were recorded in all patients.The changes in intracranial pres⁃sure,National Institutes of Health stroke scale(NIHSS)score,and Glasgow outcome scale(GOS)score at the baseline and 1d,3d,and 7d after operation were also observed.Results The operation time,hematoma clearance rate,intraoperative blood loss,and length of stay demonstrated statistical difference among patients with different bleeding sites(F=13.180,5.930,214.120,5.110,P<0.05).The pre-and post-operative intracranial pressure also yielded statistical difference among patients with different bleeding sites(F=83.100,73.840,111.690,146.820,278.990,121.560,P<0.05).The intracranial pressure changes at 3-day and 7-day after surgery manifested statisti⁃cal difference among patients with different bleeding sites(P<0.05).A decrease was found in the NIHSS scores of all patients after surgery(t=8.640,8.902,8.907,9.686,12.802,12.624,P<0.05),and the postoperative NIHSS scores showed statistical difference among patients of different bleeding sites(F=0.280,5.400,P<0.05).The good prognosis rate was 85.7%in anterior type,66.7%in medial type,72.7%in posteromedial type,47.1%in lateral type,31.4%in posterolateral type and 15.8%in mixed type,with statistical difference(χ2=19.014,P<0.05).Con⁃clusion Spontaneous bleeding from different parts of basal ganglia causes certain impacts on the time of endo⁃scopic neurosurgery,hematoma clearance rate,length of hospitalization,postoperative intracranial pressure and nerve function of the patients.