高血压壳核脑出血改良立体定向软通道微创穿刺引流术可行性研究
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摘要
目的以往临床多采用经颞硬通道微创穿刺引流术治疗高血压壳核脑出血,本研究对比其与改良立体定向软通道微创穿刺引流术,探究改良立体定向软通道微创穿刺引流术对高血压壳核脑出血患者术后血肿清除率及神经功能缺损(NIH stroke scale,NIHSS)评分的影响。方法选取2010-01-01-2018-01-31葫芦岛市连山区人民医院高血压壳核脑出血患者150例,依据治疗方案分为对照组与试验组,各75例。试验组行改良立体定向软通道微创穿刺引流术,对照组行经颞硬通道微创穿刺引流术。统计对比两组治疗效果、术后血肿清除率、并发症发生率、术前及术后3个月NIHSS及生活质量(the MOS item short from health survey,SF-36)评分。结果试验组术后3个月NIHSS评分为(12.56±1.59)分,低于对照组的(17.64±1.78)分,t=18.433,P<0.001;试验组治疗总有效率为92.00%,高于对照组的80.00%,χ~2=4.485,P=0.034;试验组>80%～100%血肿清除率为85.33%,高于对照组的50.67%,χ~2=4.015,P<0.001;试验组术后并发症发生率为6.67%,较对照组17.33%低,χ~2=4.040,P=0.044;试验组术后3个月SF-36生理功能、精神状态、社会功能和情感职能评分均较对照组高,均P<0.05。结论对高血压壳核脑出血患者行改良立体定向软通道微创穿刺引流术,可显著降低NIHSS评分及并发症发生率,有效提高血肿清除率,显著改善患者生活质量。
OBJECTIVE In the past,transtemporal hard channel minimally invasive puncture drainage were used to treat hypertensive nucleus hemorrhage.This study compares it with modified stereotactic soft channel minimally invasive puncture drainage,to explore their effects on postoperative hematoma clearance and neurological deficit(NIH Stroke Scale,NIHSS)scores in patients with hypertensive cerebral hemorrhage.METHODS A total of 150 patients with hypertensive cerebral hemorrhage in our hospital were enrolled from January 1 2010 to January 31,2018.According to the treatment plan,they were divided into control group and experimental group,with 75 cases in each group.The experimental group was performed with modified stereotactic soft channel minimally invasive puncture drainage,and the control group underwent minimally invasive puncture drainage through the hard channel.The postoperative hematoma clearance,complication rate,NIHSS and quality of life(SF-36)scores before and 3 months after surgery of the two groups were compared statistically.RESULTS At 3 months after surgery,the NIHSS score in the experimental group(12.56±1.59)was lower than that in the control group(17.64±1.78)(t=18.433,P<0.001).The total effective rate of the experimental group was 92.00%,higher than that of the control group(80.00%,χ~2=4.485,P=0.034).The hematoma clearance rate of the experimental group(85.33%)was higher than that of the control group(50.67%,χ~2=4.015,P<0.001).The postoperative complication rate of the experimental group was 6.67%,lower than that of the control group(7.33%,χ~2=4.040,P=0.044).The SF-36 score of the experimental group was higher than that of the control group at 3 months after operation(P<0.05).CONCLUSION Modified stereotactic soft-channel minimally invasive puncture drainage in patients with hypertensive cerebral hemorrhage can significantly reduce NIHSS score and complication rate,effectively improve hematoma clearance rate,and significantly improve patients' quality of life.
OBJECTIVE In the past,transtemporal hard channel minimally invasive puncture drainage were used to treat hypertensive nucleus hemorrhage.This study compares it with modified stereotactic soft channel minimally invasive puncture drainage,to explore their effects on postoperative hematoma clearance and neurological deficit(NIH Stroke Scale,NIHSS)scores in patients with hypertensive cerebral hemorrhage.METHODS A total of 150 patients with hypertensive cerebral hemorrhage in our hospital were enrolled from January 1 2010 to January 31,2018.According to the treatment plan,they were divided into control group and experimental group,with 75 cases in each group.The experimental group was performed with modified stereotactic soft channel minimally invasive puncture drainage,and the control group underwent minimally invasive puncture drainage through the hard channel.The postoperative hematoma clearance,complication rate,NIHSS and quality of life(SF-36)scores before and 3 months after surgery of the two groups were compared statistically.RESULTS At 3 months after surgery,the NIHSS score in the experimental group(12.56±1.59)was lower than that in the control group(17.64±1.78)(t=18.433,P<0.001).The total effective rate of the experimental group was 92.00%,higher than that of the control group(80.00%,χ~2=4.485,P=0.034).The hematoma clearance rate of the experimental group(85.33%)was higher than that of the control group(50.67%,χ~2=4.015,P<0.001).The postoperative complication rate of the experimental group was 6.67%,lower than that of the control group(7.33%,χ~2=4.040,P=0.044).The SF-36 score of the experimental group was higher than that of the control group at 3 months after operation(P<0.05).CONCLUSION Modified stereotactic soft-channel minimally invasive puncture drainage in patients with hypertensive cerebral hemorrhage can significantly reduce NIHSS score and complication rate,effectively improve hematoma clearance rate,and significantly improve patients' quality of life.
引文
[1]李东辉.用经侧裂岛叶血肿清除术治疗高血压壳核脑出血时采取水分离技术的效果[J].当代医药论丛,2017,15(7):12-14.
[2]Kojima D,Komoribayashi N,Omama S,et al.Crossed cerebellar tracer uptake on acute-stage 123I-iomazenil SPECT imaging predicts 3-month functional outcome in patients with nonfatal hypertensive putaminal or thalamic hemorrhage[J].Clin Nucl Med,2018,43(6):396-401.
[3]Liang KS,Yin CB,Peng LJ.Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J].Technol Health Care,2017,25(2):1-11.
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[5]郑伟杰,林运全,金永寿,等.立体定向软通道微创血肿穿刺外引流术治疗高血压脑出血的临床分析[J].微创医学,2015,10(4):460-462.
[6]侯黎明,李振,汪棋笙,等.立体定向软通道穿刺引流术治疗高血压脑出血临床疗效评价[J].白求恩医学杂志,2015,13(6):584-586.
[7]Zhou H,Yu Z,Ling L,et al.Minimally invasive stereotactic puncture and thrombolysis therap-y improves long-term outcome after acute intracerebral hemorrhage[J].J Neurol,2011,258(4):661-669.
[8]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[9]陈劲飞,肖化选,钟素雯,等.持续颅内压监测联合NIHSS量表在高血压脑出血患者的应用[J].新医学,2016,47(6):110-112.
[10]Devilliers H,Amoura Z,Besancenot JF,et al.Responsiveness of the 36-item short form health survey and the lupus quality of life questionnaire in SLE[J].Rheumatology(Oxford),2014,54(5):940-949.
[11]欧俊明.小骨窗入路治疗壳核区高血压脑出血的临床研究[J].世界临床医学,2017,11(2):18.
[12]Zhang Y,Alaref R,Fu H,et al.Neuronavigation-assisted aspiration and electro-acupuncture for Hypertensive Putaminal Hemorrhage-a suitable technique on hemiplegia rehabilitation[J].Turk Neurosurg,2017,27(4):500-508.
[13]贾晓红,危保松.改良立体定向软通道微创穿刺引流术对高血压壳核脑出血患者术后NIHSS评分及血肿清除率的影响[J].内蒙古医学杂志,2017,49(12):1472-1473.
[14]岑茂良,蒋礼源,陈光,等.改良立体定向软通道微创穿刺引流术治疗高血压壳核脑出血的疗效观察[J].广西医科大学学报,2017,34(2):257-261.
[2]Kojima D,Komoribayashi N,Omama S,et al.Crossed cerebellar tracer uptake on acute-stage 123I-iomazenil SPECT imaging predicts 3-month functional outcome in patients with nonfatal hypertensive putaminal or thalamic hemorrhage[J].Clin Nucl Med,2018,43(6):396-401.
[3]Liang KS,Yin CB,Peng LJ.Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J].Technol Health Care,2017,25(2):1-11.
[4]柴清喜,姜占涛,霍晓锋,等.经外侧裂入路微创清除壳核区脑出血临床体会[J].河南医学研究,2017,26(2):252-253.
[5]郑伟杰,林运全,金永寿,等.立体定向软通道微创血肿穿刺外引流术治疗高血压脑出血的临床分析[J].微创医学,2015,10(4):460-462.
[6]侯黎明,李振,汪棋笙,等.立体定向软通道穿刺引流术治疗高血压脑出血临床疗效评价[J].白求恩医学杂志,2015,13(6):584-586.
[7]Zhou H,Yu Z,Ling L,et al.Minimally invasive stereotactic puncture and thrombolysis therap-y improves long-term outcome after acute intracerebral hemorrhage[J].J Neurol,2011,258(4):661-669.
[8]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[9]陈劲飞,肖化选,钟素雯,等.持续颅内压监测联合NIHSS量表在高血压脑出血患者的应用[J].新医学,2016,47(6):110-112.
[10]Devilliers H,Amoura Z,Besancenot JF,et al.Responsiveness of the 36-item short form health survey and the lupus quality of life questionnaire in SLE[J].Rheumatology(Oxford),2014,54(5):940-949.
[11]欧俊明.小骨窗入路治疗壳核区高血压脑出血的临床研究[J].世界临床医学,2017,11(2):18.
[12]Zhang Y,Alaref R,Fu H,et al.Neuronavigation-assisted aspiration and electro-acupuncture for Hypertensive Putaminal Hemorrhage-a suitable technique on hemiplegia rehabilitation[J].Turk Neurosurg,2017,27(4):500-508.
[13]贾晓红,危保松.改良立体定向软通道微创穿刺引流术对高血压壳核脑出血患者术后NIHSS评分及血肿清除率的影响[J].内蒙古医学杂志,2017,49(12):1472-1473.
[14]岑茂良,蒋礼源,陈光,等.改良立体定向软通道微创穿刺引流术治疗高血压壳核脑出血的疗效观察[J].广西医科大学学报,2017,34(2):257-261.