立体定向穿刺引流术在基底节区自发性脑出血治疗中的临床研究

Clinical study of stereotactic puncture drainage treatment in spontaneous intracerebral hemorrhage in the basal ganglia

目的探讨立体定向穿刺引流术与保守治疗对基底节区自发性脑出血患者预后的影响。方法回顾性分析2019年01月至2021年12月在我科接受治疗的65例自发性基底节区脑出血(GCS>8分,出血量20~40ml)患者,按照治疗的方式分为手术组32例,采用立体定向穿刺引流联合溶栓药物使用治疗;保守治疗组33例。根据两组患者住院期间及12个月的随访资料,在一般基线资料、住院时间、并发症、格拉斯哥预后量表评分(GOS)、改良Rankin评分(mRS)及改良的Barthel指数(MBI)等方面进行对比。结果两组在年龄、性别、血肿量、高血压相关因素等基线资料差异无统计学意义(P>0.05)。两组在入院、入院1周及出院时GCS评分比较差异无统计学意义(P>0.05)。两组患者入院1周时血肿清除率分别为87.18±4.49%、25.75±3.04%;平均住院时间分别为(12.13±1.75)d、(16.97±1.64)d;住院期间肺部感染率分别为25%(8/32)、48.5%(16/33),其差异有统计学意义(P<0.05)。术后1个月、3个月、6个月及12个月的4次随访中两组患者在GOS评分、mRS评分及MBI方面差异均有统计学意义(P<0.05)。结论基底节区出血在20~40ml且入院时GCS>8分的患者,立体定向穿刺引流联合溶栓药物使用的总体疗效对比保守治疗具有明显的优势。

Objective To investigate the influences of stereotactic puncture drainage treatment and conservative treatment in clinical prognoses of patients with spontaneous intracerebral hematoma in the basal ganglia.Methods A retrospective analysis of Sixty-five patients with spontaneous basal ganglia cerebral hemorrhage(Glasgow comascale(GCS)>8scores and hemorrhage volume 20ml to 40ml)admitted to our department from January 2019to December 2021.All patients were divided into surgical group(accepted stereotactic puncture drainage with thrombolysis treatment,n=32)and conservative treatment group(n=33).The data during hospitalization and 12months follow-up data of patients from the 2groups were compared.The baseline general data,average hospitalization time,complications,Glasgow outcome scale(GOS)scores,modified Rankin scale(mRS)scores and modified Barthel index(MBI)were compared after treatment.Results There were no significant differences in age,gender,volume of bleeding and hypertension related factors between the 2groups(P>0.05).There were no significant differences in GCS on admission,one week after admission and discharge between the 2groups(P>0.05).The hematoma clearance rate at 1week after admission was 87.18±4.49%,average hospitalization time was(12.13±1.75)d and the rate of pulmonary infection on admission was 25%(8/32)on admission in surgical group and that in conservative treatment group with hematoma clearance rate was 25.75±3.04%,average hospitalization day was(16.97±1.64)d and the rate of pulmonary infection on admission was 48.5%(16/33),the differences between the 2groups were statistically significant(P<0.05).There were significant differences in GOS scores,mRS scores and MBI between the 2groups in the four follow-up of 1month,3months,6months and 12months afte treatment(P<0.05).Conclusion The overall efficacy of stereotactic puncture drainage with thrombolysis has more obvious advantages in patients with cerebral hemorrhage volume of 20ml to 40ml in the basal ganglia and GCS>8scores than conservative treatment.