精准调控置管引流术治疗高血压性脑出血的疗效观察

Observation on cerebral perfusion changes and efficacy after precise control of catheter drainage in the treatment of hypertensive cerebral hemorrhage

目的观察置管引流术术中、术后全程采用精准调控血肿引流模式治疗高血压性脑出血的疗效及其对脑灌注的影响.方法前瞻性纳入2021年1月至2023年1月湖南省脑科医院神经外科收治的基底核-丘脑区出血患者,采用随机数字表法将其随机分为精准调控血肿引流组(试验组)和常规血肿引流组(对照组).比较两组患者术前的临床资料、手术时长、术后24 h残余血肿量、术后72 h内血肿再扩大情况,术后第5天行磁共振灌注加权成像(PWI)检查,观察两组患者血肿区及半暗带区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及达峰时间(TTP)的差异;术后6个月,评估两组患者的日常生活能力(ADL)评分.结果两组患者的年龄、性别、术前格拉斯哥昏迷评分(GCS)、血肿侧别、脑实质内血肿量及Graeb评分的差异均无统计学意义(均P>0.05).试验组、对照组的手术时长分别为(108.8±9.1)min、(92.0±5.6)min,术后24 h残余血肿量分别为(18.1±2.2)ml、(25.1±2.8)ml,术后6个月ADL评分分别为(72.5±22.2)分、(61.5±23.9)分,上述指标的差异均有统计学意义(均P<0.05);术后72 h血肿增大的患者分别为0、5例(P=0.065).术后第5天PWI结果显示,与对照组比较,试验组血肿区、半暗带区的CBF、CBV值均增加,MTT、TTP值均缩短,差异均有统计学意义(均P<0.01).结论高血压性脑出血置管引流手术全程采取精准调控血肿引流模式,虽然可能延长手术时间,但更加有利于血肿的引流、改善血肿及其周边区域的血流灌注及患者的预后.

Objective To observe the efficacy of precisely controlled hematoma drainage mode in the treatment of hypertensive cerebral hemorrhage during and after catheter drainage and its impact on cerebral perfusion.Methods Patients with basal ganglia-thalamic area hemorrhage admitted to the Neurosurgery Department of Hunan Brain Hospital of Hunan Province from January 2021 to January 2023 were prospectively included,and they were randomly divided into a precision-controlled hematoma drainage group(experimental group)and a conventional hematoma drainage group(control group)using the random number table method.The preoperative clinical data,operation duration,residual hematoma volume 24 hours after operation,and hematoma re-expansion within 72 hours after operation were compared between the two groups of patients.Magnetic resonance perfusion-weighted imaging(PWI)examination was performed on the 5th day after operation in the two groups to analyzed their differences in cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)in the hematoma area and penumbra zone of the patients.At 6 months after surgery,the daily life of the two groups of patients was evaluated based on the ADL(Activities of Daily Living)scores.Results There were no statistically significant differences in age,gender,preoperative Glasgow Coma Score(GCS),hematoma side,intraparenchymal hematoma volume,or Graeb score between the two groups(all P>0.05).The operation duration of the experimental group and the control group were 108.8±9.1 min and 92.0±5.6 min respectively,the residual hematoma volume at 24 hours after operation was 18.1±2.2 ml and 25.1±2.8 ml,the ADL scores at 6 months after operation were 72.5±22.2 and 61.5±23.9 respectively,arid the differences in the above indicators were statistically significant(all P<0.05).The number of patients with hematoma enlargement at 72 hours after surgery was 0 and 5 in the experimental and control groups respectively(P=0.065).The PWI results on the 5th day after surgery showed that compared with the control group,the CBF and CBV values in the hematoma area and penumbra area of the experimental group were increased,the MTT and TTP values were shortened,and the differences were statistically significant(all P<0.01).Conclusion Application of precise control of the hematoma drainage mode in the whole process of catheterization and drainage surgery for hypertensive cerebral hemorrhage may prolong the operation time,while it may facilitate the drainage of the hematoma,enhance the blood perfusion of the hematoma and its surrounding areas,and improve the patient's prognosis.