经额定向穿刺引流术治疗基底节区高血压脑出血的疗效及安全性
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摘要
目的探讨经额定向穿刺引流术治疗基底节区高血压脑出血的临床效果及安全性。方法选择2016年1月至2017年6月汉中市中心医院收治的124例基底节区高血压脑出血患者为研究对象,根据手术方式将患者分为开颅手术组(72例)和穿刺引流组(52例)。穿刺引流组患者采用经额定向穿刺引流术治疗,开颅手术组患者采用开颅血肿清除术治疗,对2组患者的手术时间、术中出血量、术后引流量、术后并发症、首次下床活动时间、住院时间、术后1个月神经功能及术后6个月日常生活活动能力(ADL)进行比较。结果穿刺引流组患者的手术时间、首次下床活动时间、住院时间显著短于开颅手术组(t=12.038、4.375、5.113,P<0.01),穿刺引流组患者术中出血量和术后引流量显著少于开颅手术组(t=9.427、8.804,P<0.01)。术后1个月,穿刺引流组患者中国脑卒中临床神经功能缺损程度量表评分和美国国立卫生研究院卒中量表评分显著低于开颅手术组(t=6.164、6.309,P<0.01)。术后6个月,穿刺引流组和开颅手术组患者ADL良好率分别为90.4%(47/52)、68.1%(49/72),穿刺引流组患者ADL良好率显著高于开颅手术组(χ2=8.542,P<0.01)。穿刺引流组和开颅手术组患者术后并发症发生率分别为9.6%(5/52)、36.1%(26/72),穿刺引流组患者术后并发症发生率显著低于开颅手术组(χ2=11.214,P<0.01)。结论经额定向穿刺引流术治疗基底节区高血压脑出血可以缩短手术时间,减少术中出血量,有效促进患者神经功能及ADL恢复,降低术后并发症发生率。
Objective To investigate the effect and safety of transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Methods A total of 124 patients with hypertensive cerebral hemorrhage in basal ganglia in Hanzhong Central Hospital from January 2016 to June 2017 were selected as the subjects.The patients were divided into craniotomy group(n=72) and puncture drainage group(n=52) according to the operative method.The patients in the puncture-drainage group were treated with transfrontal stereotactic puncture and drainage,and the patients in the craniotomy group were treated with craniotomy and hematoma removal.The operation time,intraoperative bleeding,postoperative drainage,postoperative complications,the time of first ambulation,hospitalization time,the nerve function of one month after operation and the activities of daily living(ADL) of six months after operation were compared between the two groups.Results The operation time,the time of first ambulation and the hospitalization time in the puncture drainage group were significantly shorter than those in the craniotomy group(t=12.038,4.375,5.113;P<0.01).The intraoperative bleeding and postoperative drainage in the puncture drainage group were significantly less than those in the craniotomy group(t=9.427,8.804;P<0.01).The scores of China stroke scale and the national institute of health stroke scale in the puncture drainage group were significantly lower than those in the craniotomy group at one month after operation(t=6.164,6.309;P<0.01).The fineness rate of ADL in the puncture drainage group and the craniotomy group was 90.4%(47/52) and 68.1%(49/72) respectively at six months after operation,the fineness rate of ADL in the puncture drainage group was significantly higher than that in the craniotomy group(χ~2=8.542,P<0.01).The incidence of postoperative complications in the puncture drainage group and the craniotomy group was 9.6%(5/52) and 36.1%(26/72) respectively,the incidence of postoperative complications in the puncture drainage group was significantly lower than that in the craniotomy group(χ~2=11.214,P<0.01).Conclusion Transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region can shorten the operation time,reduce the intraoperative bleeding,effectively promote the recovery of neurological function and ADL,and reduce the incidence of postoperative complications.
Objective To investigate the effect and safety of transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region.Methods A total of 124 patients with hypertensive cerebral hemorrhage in basal ganglia in Hanzhong Central Hospital from January 2016 to June 2017 were selected as the subjects.The patients were divided into craniotomy group(n=72) and puncture drainage group(n=52) according to the operative method.The patients in the puncture-drainage group were treated with transfrontal stereotactic puncture and drainage,and the patients in the craniotomy group were treated with craniotomy and hematoma removal.The operation time,intraoperative bleeding,postoperative drainage,postoperative complications,the time of first ambulation,hospitalization time,the nerve function of one month after operation and the activities of daily living(ADL) of six months after operation were compared between the two groups.Results The operation time,the time of first ambulation and the hospitalization time in the puncture drainage group were significantly shorter than those in the craniotomy group(t=12.038,4.375,5.113;P<0.01).The intraoperative bleeding and postoperative drainage in the puncture drainage group were significantly less than those in the craniotomy group(t=9.427,8.804;P<0.01).The scores of China stroke scale and the national institute of health stroke scale in the puncture drainage group were significantly lower than those in the craniotomy group at one month after operation(t=6.164,6.309;P<0.01).The fineness rate of ADL in the puncture drainage group and the craniotomy group was 90.4%(47/52) and 68.1%(49/72) respectively at six months after operation,the fineness rate of ADL in the puncture drainage group was significantly higher than that in the craniotomy group(χ~2=8.542,P<0.01).The incidence of postoperative complications in the puncture drainage group and the craniotomy group was 9.6%(5/52) and 36.1%(26/72) respectively,the incidence of postoperative complications in the puncture drainage group was significantly lower than that in the craniotomy group(χ~2=11.214,P<0.01).Conclusion Transfrontal stereotactic puncture and drainage in the treatment of hypertensive cerebral hemorrhage in basal ganglia region can shorten the operation time,reduce the intraoperative bleeding,effectively promote the recovery of neurological function and ADL,and reduce the incidence of postoperative complications.
引文
[1]张康,王芳,李文平,等.显微经侧裂入路手术治疗高血压脑出血的疗效分析[J].环球中医药,2015,8(S2):27.
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[6]钱东翔.高血压脑出血微创血肿穿刺引流治疗进展[J/CD].中华神经创伤外科电子杂志,2015,1(2):44-48.DOI:10.3877/cma.j.issn.2095-9141.2015.02.013.
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[9]王震,佘晓春,李金林,等.高血压脑出血患者小骨窗开颅术后神经功能评估[J].环球中医药,2015,11(S1):245.
[10]马士朋.高血压脑出血外科治疗手术方式的研究进展[J].医药前沿,2017,7(13):9-10.
[11]官卫,王强,马涛,等.经额定向穿刺引流术与开颅血肿清除术治疗基底节区出血的前瞻性对照研究[J].中华神经外科杂志,2017,33(2):169-172.
[12]梁日初,周敏,廖勇仕,等.小骨窗开颅与硬通道穿刺治疗高血压脑出血的对比[J].中国现代医学杂志,2015,25(16):66-69.
[13]周强,刘红,张维波.微创穿刺清除术在基底节区脑出血治疗中的临床应用[J].中国临床保健杂志,2014,17(2):147-149.
[14]胡怡勇,邓文娟,邓丽娟.早期微创穿刺碎吸引流术治疗中小量基底核区高血压性脑出血疗效观察[J].新乡医学院学报,2016,33(9):798-800.
[15]曹栓柱,王艳州,李金泉,等.微创穿刺引流术治疗基底节区高血压脑出血对水肿带变化的影响[J].中国实用神经疾病杂志,2015,18(21):4-6.
[16]方建喜,何明球,姚辉,等.CT定位下微创穿刺治疗高血压基底节区脑出血短期疗效分析[J].医学理论与实践,2017,30(22):3329-3330.
[2]聂晓枫,杨军,吕智龙.醒脑静注射液联合微创穿刺引流术治疗对中等量高血压性基底节区脑出血患者脑水肿及血清AQP4的影响[J].临床和实验医学杂志,2017,16(18):1838-1841.
[3]刘宇梁,王建伟,李凤利,等.微创穿刺血肿清除术治疗基底节区高血压脑出血疗效观察[J].现代中西医结合杂志,2015,24(36):4069-4071.
[4]岑茂良,蒋礼源,陈光,等.高血压脑出血治疗进展[J].临床医学研究与实践,2016,1(11):186-187.
[5]郑虎,张红波,袁辉胜,等.CT辅助下立体定向穿刺引流术治疗基底节区脑出血的疗效分析[J].临床神经外科杂志,2016,13(5):386-388.
[6]钱东翔.高血压脑出血微创血肿穿刺引流治疗进展[J/CD].中华神经创伤外科电子杂志,2015,1(2):44-48.DOI:10.3877/cma.j.issn.2095-9141.2015.02.013.
[7]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:257-271.
[8]官卫,杨常春,刘春波,等.简易经额部入路定向穿刺术治疗基底节区脑出血初步经验[J/CD].中华临床医师杂志:电子版,2015,9(4):698-701.DOI:10.3877/cma.j.issn.1674-0785.2015.04.042.
[9]王震,佘晓春,李金林,等.高血压脑出血患者小骨窗开颅术后神经功能评估[J].环球中医药,2015,11(S1):245.
[10]马士朋.高血压脑出血外科治疗手术方式的研究进展[J].医药前沿,2017,7(13):9-10.
[11]官卫,王强,马涛,等.经额定向穿刺引流术与开颅血肿清除术治疗基底节区出血的前瞻性对照研究[J].中华神经外科杂志,2017,33(2):169-172.
[12]梁日初,周敏,廖勇仕,等.小骨窗开颅与硬通道穿刺治疗高血压脑出血的对比[J].中国现代医学杂志,2015,25(16):66-69.
[13]周强,刘红,张维波.微创穿刺清除术在基底节区脑出血治疗中的临床应用[J].中国临床保健杂志,2014,17(2):147-149.
[14]胡怡勇,邓文娟,邓丽娟.早期微创穿刺碎吸引流术治疗中小量基底核区高血压性脑出血疗效观察[J].新乡医学院学报,2016,33(9):798-800.
[15]曹栓柱,王艳州,李金泉,等.微创穿刺引流术治疗基底节区高血压脑出血对水肿带变化的影响[J].中国实用神经疾病杂志,2015,18(21):4-6.
[16]方建喜,何明球,姚辉,等.CT定位下微创穿刺治疗高血压基底节区脑出血短期疗效分析[J].医学理论与实践,2017,30(22):3329-3330.