基底核区高血压脑出血患者穿刺引流置管靶点的位置与血肿清除率及神经功能的关系研究

Relationship between the Location of Puncture Drainage Catheter Target and Hematoma Clearance Rate and Neurological Function in Patients with Basal Ganglia Hypertensive Intracerebral Hemorrhage

目的探讨基底核区高血压脑出血(HICH)患者穿刺引流置管靶点的位置与血肿清除率及神经功能的关系。方法回顾性选取2018—2021年就诊于郑州大学第二附属医院神经外科的基底核区HICH患者30例为研究对象,将患者原始DICOM数据导入3D Slicer 4.0.10.2中,勾勒出基底核亚区不同解剖结构。重建出三维大脑半球镶嵌模型后,导出其光刻模型。使用Geomagic 2015及Solidworks 2019将脑组织模型实体化,再分割、修整后,生成工业标准格式(.x_t)模型,将模型导入ANSYS 2020 R2软件,对血流与脑组织进行瞬态双向流固耦合(BSFC)。根据穿刺引流置管靶点的位置是否位于血肿强应力区将患者分为强应力组(置管靶点等效应力与血肿应力最大值比值>74%,19例)和弱应力组(置管靶点等效应力与血肿应力最大值比值≤74%,11例)。收集患者性别、年龄、出血部位、术后水肿量、术后3 d血肿清除率、术后2周格拉斯哥昏迷量表(GCS)评分与术前差值以及拔管时间。结果强应力组与弱应力组性别、年龄、出血部位、术后水肿量、拔管时间比较,差异无统计学意义(P>0.05);强应力组术后3 d血肿清除率、术后2周GCS评分与术前差值高于弱应力组(P<0.05)。结论基底核区HICH患者穿刺引流置管靶点的位置可能影响其术后血肿清除率及GCS评分,提示术前应快速建立模型,确定血肿应力中心,利用神经导航将置管靶点设置在强应力区,从而促进血肿引流,改善患者神经功能。

Objective To investigate the relationship between the location of puncture drainage catheter target and hematoma clearance rate and neurological function in patients with basal ganglia hypertensive intracerebral hemorrhage(HICH).Methods A total of 30 patients with basal ganglia HICH in Department of Neurosurgery of the Second Affiliated Hospital of Zhengzhou University from 2018 to 2021 were retrospectively selected as the research objects.The patients'original DICOM data were imported into 3D Slicer 4.0.10.2,and the different anatomical structures of the basal ganglia subregion were outlined.After reconstructing the three-dimensional cerebral hemisphere mosaic model,the lithography model was derived.Geomagic 2015 and Solidworks 2019 were used to materialize the brain tissue model,and after segmentation and trimming,an industrial standard format(.x_t)model was generated.The model was imported into the ANSYS 2020 R2 software to conduct transient bidirectional structure-fluid coupling(BSFC)between blood flow and brain tissue.Patients were divided into strong stress group(ratio of equivalent stress at the catheter target to the maximum stress inside the hematoma was derived>74%,n=19)and weak stress group(ratio of equivalent stress at the catheter target to the maximum stress inside the hematoma was derived≤74%,n=11)according to whether the location of puncture drainage catheter target was located in the hematoma strong stress area.Gender,age,bleeding site,postoperative edema volume,hematoma clearance rate at 3 days after surgery,the difference of the Glasgow Coma Scale(GCS)score between 2 weeks after surgery and before surgery and extubation time of patients were collected.Results There was no statistically significant difference in gender,age,bleeding site,postoperative edema volume,and extubation time between strong stress group and weak stress group(P>0.05).The hematoma clearance rate at 3 days after surgery,the difference of the GCS score between 2 weeks after surgery and before surgery in the strong stress group were higher than those in the weak stress group(P<0.05).Conclusion The location of puncture drainage catheter target in patients with basal ganglia HICH may affect the hematoma clearance rate after surgery and GCS score.Before surgery,a model should be quickly established,determine the stress center of hematoma and using neuronavigation to set the target point of tube placement as a strong stress area,in order to promote the drainage of hematoma and improve the neurological function of patients.