不同手术时机的立体定向穿刺引流术治疗高血压性基底节区脑出血的疗效及预后研究

Treatment of Hypertensive Basal Ganglia Intracerebral hemorrhage with Stereotactic Puncture and Drainage at Different Operative Times

目的 探讨不同手术时机的立体定向穿刺引流术对高血压性基底节区脑出血的疗效及其预后研究。方法 选择2015年4月至2019年12月于我院神经外科住院治疗的高血压性基底节区脑出血患者165例,根据不同手术时机进行微创穿刺引流术,将患者分为A组20例(发病6h内)、B组55例(发病6~24h内)、C组50例(发病24~72h内)、D组40例。其中,40例予以开颅手术治疗(D组),收集所有患者的临床资料,比较各组入院前和出院后的格拉斯哥昏迷评分(GCS)、住院期间再出血率。出院后随访,比较各组治疗后1个月和6个月的预后情况[格拉斯哥预后评分(GOS)、改良Rankin评分(mRS)、Barthel指数评分(BI)]。结果 微创手术治疗组(A~C组)较开颅手术组(D组)手术时间和出血量明显减少,再出血率明显降低,GCS评分明显升高,血肿量明显降低(P<0.05)。在不同时机的微创手术比较,B组(6~24h内)与A组(6h内)和C组(24~72h)比较,GCS评分明显升高,术后2周血肿量明显降低(P<0.05)。术后随访1个月和6个月后,B组患者的GOS评分和BI评分明显高于其他组,mRS评分明显低于其他组,而微创手术治疗组(A~C组)与开颅手术组(D组)比较,GOS评分和BI评分明显升高,mRS评分明显降低,差异有统计学意义(P<0.05)。结论 微创手术治疗高血压性基底节脑出血的疗效和预后明显比开颅手术好,而6~24h内进行立体定向微创穿刺引流术的疗效和预后最为明显。

Objective To investigate the effect of stereotactic puncture and drainage on hypertensive basal ganglia cerebral hemorrhage and its prognosis.Methods 165 patients with hypertensive basal ganglia cerebral hemorrhage who were hospitalized in the department of neurology of our hospital from April 2015 to December 2019 were selected,according to the different operation timing,the minimally invasive puncture and drainage were divided into group A(20 cases within 6h after onset),group B(55 cases within 6~24h after onset)and group C(50 cases within 24~72h after onset),clinical data of all patients were collected,the Glasgow coma score(GCS)and the rate of rebleeding during hospitalization were compared between each group before admission and after discharge;Follow-up was conducted after discharge to compare the prognosis[Glasgow prognosis score(GOS),improved Rankin score(mRS),Barthel index score(BI)]of each group at 1 and 6 months after treatment.Results Compared with the craniotomy group(group D),the operation time and blood loss of the minimally invasive surgery group(group A~C)were significantly reduced,the rate of rebleeding was significantly reduced,the GCS score was significantly increased,and the amount of hematoma was significantly reduced(P<0.05);For comparison of minimally invasive surgery at different times,group B(within 6~24h)was compared with group A(within 6h)and group C(24~72h),GCS score was significantly increased,and hematoma volume was significantly reduced 2 weeks after surgery(P<0.05);After 1 and 6 months of postoperative follow-up,GOS and BI scores of patients were significantly higher in the group B than those in other groups,and mRS scores were significantly lower than those in other groups.GOS and BI scores were significantly higher and mRS scores were significantly lower in the minimally invasive surgery group(group A~C)than in the craniotomy group(group D),and the difference was statistically significant(P<0.05).Conclusion The curative effect and prognosis of minimally invasive surgery for hypertensive basal ganglia cerebral hemorrhage were significantly higher than that of craniotomy group,and the curative effect and prognosis of minimally invasive stereotactic puncture and drainage within 6~24h were the most obvious.