脑出血颅内血肿微创穿刺引流术首次血肿抽吸率与神经功能恢复相关性分析
|
摘要
目的分析脑出血颅内血肿微创穿刺引流术首次血肿抽吸率与神经功能恢复的相关性,为治疗脑出血提供理论依据。方法选取2014年1月至2017年6月我院接诊的91例脑出血患者,根据患者首次血肿抽吸率分为三组,比较三组患者术后第3、7、14天血肿清除情况、水肿体积变化、术后再出血例数以及患者神经功能恢复状况NIHSS评分结果等指标。结果三组患者术后第3、7、14天水肿体积变化、残余血肿清除率和NIHSS评分差异有统计学意义(P <0. 05)。患者首次血肿抽吸率与术后水肿体积变化、NIHSS评分结果呈负相关,与残余血肿清除率呈正相关。患者术后第3、7、14天NIHSS评分与水肿体积呈正相关,与残余血肿清除率呈负相关;残余血肿清除率与水肿体积呈负相关。A、C组再出血患者各1例,B组再出血患者2例,三组再出血率比较差异无统计学意义(P=0. 98)。结论脑出血颅内血肿微创穿刺引流术首次血肿抽吸率高的患者其血肿周围水肿体积减少,残余血肿清除率提高,患者神经功能恢复状况良好。
Objective To analyze the relationship between the first hematoma aspiration rate and the recovery of neurological function in the minimally invasive puncture drainage for intracranial hematoma in patients with cerebral hemorrhage in order to provide a theoretical basis for the treatment of cerebral hemorrhage.Methods We selected 91 patients with cerebral hemorrhage who were admitted to our hospital from January 2014 to June 2017.The patients were divided into three groups according to the first hematoma aspiration rate.The hematoma clearance and indicators such as edema volume change,number of postoperative re-bleeding cases,and NIHSS scores of patients with neurological recovery were compared on the 3rd,7 th and 14 th postoperative day among the three groups.Results There were significant differences in edema volume,residual hematoma clearance rate and NIHSS score on the 3rd,7 th and 14 th day after operation among the three groups( P < 0. 05).The first hematoma aspiration rate was negatively correlated with postoperative edema volume and NIHSS scores,but positively correlated with residual hematoma clearance. The NIHSS score was positively correlated with edema volume on the 3rd,7 th and 14 th postoperative day,but negatively correlated with residual hematoma clearance rate.The residual hematoma clearance rate was negatively correlated with edema volume.Re-bleeding occurred in 1 case each in the group A and C,and 2 cases in the group B but the difference did not reach statistically significant( P = 0. 98).Conclusion For patients with firsttime high hematoma aspiration rate,their volume of edema around the hematoma is decreased,the residual hematoma clearance rate is increased,and their neurological function would be recovered well.
Objective To analyze the relationship between the first hematoma aspiration rate and the recovery of neurological function in the minimally invasive puncture drainage for intracranial hematoma in patients with cerebral hemorrhage in order to provide a theoretical basis for the treatment of cerebral hemorrhage.Methods We selected 91 patients with cerebral hemorrhage who were admitted to our hospital from January 2014 to June 2017.The patients were divided into three groups according to the first hematoma aspiration rate.The hematoma clearance and indicators such as edema volume change,number of postoperative re-bleeding cases,and NIHSS scores of patients with neurological recovery were compared on the 3rd,7 th and 14 th postoperative day among the three groups.Results There were significant differences in edema volume,residual hematoma clearance rate and NIHSS score on the 3rd,7 th and 14 th day after operation among the three groups( P < 0. 05).The first hematoma aspiration rate was negatively correlated with postoperative edema volume and NIHSS scores,but positively correlated with residual hematoma clearance. The NIHSS score was positively correlated with edema volume on the 3rd,7 th and 14 th postoperative day,but negatively correlated with residual hematoma clearance rate.The residual hematoma clearance rate was negatively correlated with edema volume.Re-bleeding occurred in 1 case each in the group A and C,and 2 cases in the group B but the difference did not reach statistically significant( P = 0. 98).Conclusion For patients with firsttime high hematoma aspiration rate,their volume of edema around the hematoma is decreased,the residual hematoma clearance rate is increased,and their neurological function would be recovered well.
引文
[1]Vial F,Brunser A,Lavados P,et al.Intraventricular Bleeding and Hematoma Size as Predictors of Infection Development in Intracerebral Hemorrhage:A Prospective Cohort Study[J].Journal of Stroke&Cerebrovascular Diseases,2016,25(11):2708-2711.
[2]赵锦阳,刘刚,黎亮.微创颅内血肿抽吸术治疗创伤性脑出血的临床效果及其对神经功能的影响[J].实用心脑肺血管病杂志,2017,25(9):92-95.
[3]Wu G,Jiao Y,Wu J,et al.Rosiglitazone Infusion Therapy Following Minimally Invasive Surgery for Intracranial Hemorrhage Evacuation Decreased Perihematomal Glutamate Content and Blood-Brain Barrier Permeability in Rabbits[J].Bmc Neurology,2018,15(1):37-40.
[4]杨春光,王艳阳,白永杰,等.脑血疏口服液治疗脑出血微创引流术后继发神经功能损害的临床观察[J].中西医结合心脑血管病杂志,2017,15(17):2205-2207.
[5]官卫,马涛,刘春波,等.微创穿刺抽吸引流术治疗脑出血合并脑疝的可行性探讨[J].中国微侵袭神经外科杂志,2016,21(12):553-554.
[6]陈振翼,方邦江,刘月,等.急性脑梗死不同中医证型与NIHSS评分时相性演变的相关性研究[J].中国中医急症,2017,26(7):1129-1133.
[7] Veitch AM,Vanbiervliet G,Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy,including direct oral anticoagulants:British Society of Gastroenterology(BSG)and European Society of Gastrointestinal Endoscopy(ESGE)guidelines[J].Endoscopy,2016,65(3):374-389.
[8]Di BL,Mohanty P,Mohanty S,et al. Ablation vs. Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device:Results From the AATAC Multicenter Randomized Trial[J].Circulation,2016,133(17):1637.
[9]丁宇,李军凤,周鸣,等.微创颅内血肿抽吸术对高血压脑出血患者B型脑钠肽、C反应蛋白、同型半胱氨酸及生活质量的影响[J].成都医学院学报,2017,12(5):585-589.
[10]杨永青,杨瑞林,赵志靖,等.微创下置管抽吸液化引流手术治疗脑出血的临床效果及对神经功能、炎性因子水平的影响[J].疑难病杂志,2016,15(9):912-915.
[11]Dasa O,Shafiq Q,Ruzieh M,et al.Patient Factors But Not the Use of Novel Anticoagulants or Warfarin Are Associated With Internal Jugular Vein Access-Site Hematoma After Right Heart Catheterization[J].Journal of Invasive Cardiology,2017,29(12):401-403.
[12]胡世颉,吕超,胡学安,等.不同引流方案治疗大量基底节区高血压脑出血患者的疗效对比[J].医学临床研究,2016,33(11):2140-2142.
[13]Winters BD,Bharmal A,Wilson RF,et al.Validity of the agency for health care research and quality patient safety indicators and the centers for medicare and medicaid hospital-acquired conditions:a systematic review and meta-analysis[J]. Medical Care,2016,54(12):1105-1109.
[14]施超杰,任洪清,宋张平,等.微创钻颅脑内血肿穿刺抽吸引流术治疗高龄急性高血压脑出血的疗效[J].江苏医药,2017,43(20):1505-1506.
[15]Xu M,Lei C,Liu M,et al. Influence of end-stage renal disease on hematoma volume and intraventricular hemorrhage in patients with intracerebral hemorrhage:a cohort study and meta-analysis.[J].European Neurology,2016,75(2):33-40.
[16]何晓云.大骨瓣开颅血肿清除术、小骨窗显微血肿清除术和钻孔血肿抽吸引流术治疗高血压脑出血临床疗效对比观察[J].临床和实验医学杂志,2016,15(16):1612-1614.
[17]Huh J,Yang SY,Huh HY,et al.Compare the intracranial pressure trend after the decompressive craniectomy between massive intracerebral hemorrhagic and major ischemic stroke patients[J].Journal of Korean Neurosurgical Society,2018,61(1):42-45.
[18]张超勇,滑祥廷,李佳.锥颅血肿抽吸引流术与常规内科疗法治疗基底节区脑出血的疗效比较[J].实用临床医药杂志,2016,20(7):129-130.
[19]Hulou MM,Abdelbarr MM,Gormley WB,et al. The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle.[J]. British Journal of Neurosurgery,2016,30(4):438-443.
[20]谭支强.CT引导立体定向血肿抽吸术与保守治疗对基底节区高血压性脑出血患者的临床疗效分析[J].实用临床医药杂志,2017,21(5):113-114.
[21]Gerner ST,Kuramatsu JB,Sembill JA,et al.Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage[J].Annals of Neurology,2018,83(1):186-196.
[22]杨学,陈劲草,张雪梅.小骨窗开颅与立体定向置管抽吸治疗基底节区高血压脑出血的临床研究[J].中西医结合心脑血管病杂志,2016,14(13):1472-1474.
[2]赵锦阳,刘刚,黎亮.微创颅内血肿抽吸术治疗创伤性脑出血的临床效果及其对神经功能的影响[J].实用心脑肺血管病杂志,2017,25(9):92-95.
[3]Wu G,Jiao Y,Wu J,et al.Rosiglitazone Infusion Therapy Following Minimally Invasive Surgery for Intracranial Hemorrhage Evacuation Decreased Perihematomal Glutamate Content and Blood-Brain Barrier Permeability in Rabbits[J].Bmc Neurology,2018,15(1):37-40.
[4]杨春光,王艳阳,白永杰,等.脑血疏口服液治疗脑出血微创引流术后继发神经功能损害的临床观察[J].中西医结合心脑血管病杂志,2017,15(17):2205-2207.
[5]官卫,马涛,刘春波,等.微创穿刺抽吸引流术治疗脑出血合并脑疝的可行性探讨[J].中国微侵袭神经外科杂志,2016,21(12):553-554.
[6]陈振翼,方邦江,刘月,等.急性脑梗死不同中医证型与NIHSS评分时相性演变的相关性研究[J].中国中医急症,2017,26(7):1129-1133.
[7] Veitch AM,Vanbiervliet G,Gershlick AH,et al. Endoscopy in patients on antiplatelet or anticoagulant therapy,including direct oral anticoagulants:British Society of Gastroenterology(BSG)and European Society of Gastrointestinal Endoscopy(ESGE)guidelines[J].Endoscopy,2016,65(3):374-389.
[8]Di BL,Mohanty P,Mohanty S,et al. Ablation vs. Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device:Results From the AATAC Multicenter Randomized Trial[J].Circulation,2016,133(17):1637.
[9]丁宇,李军凤,周鸣,等.微创颅内血肿抽吸术对高血压脑出血患者B型脑钠肽、C反应蛋白、同型半胱氨酸及生活质量的影响[J].成都医学院学报,2017,12(5):585-589.
[10]杨永青,杨瑞林,赵志靖,等.微创下置管抽吸液化引流手术治疗脑出血的临床效果及对神经功能、炎性因子水平的影响[J].疑难病杂志,2016,15(9):912-915.
[11]Dasa O,Shafiq Q,Ruzieh M,et al.Patient Factors But Not the Use of Novel Anticoagulants or Warfarin Are Associated With Internal Jugular Vein Access-Site Hematoma After Right Heart Catheterization[J].Journal of Invasive Cardiology,2017,29(12):401-403.
[12]胡世颉,吕超,胡学安,等.不同引流方案治疗大量基底节区高血压脑出血患者的疗效对比[J].医学临床研究,2016,33(11):2140-2142.
[13]Winters BD,Bharmal A,Wilson RF,et al.Validity of the agency for health care research and quality patient safety indicators and the centers for medicare and medicaid hospital-acquired conditions:a systematic review and meta-analysis[J]. Medical Care,2016,54(12):1105-1109.
[14]施超杰,任洪清,宋张平,等.微创钻颅脑内血肿穿刺抽吸引流术治疗高龄急性高血压脑出血的疗效[J].江苏医药,2017,43(20):1505-1506.
[15]Xu M,Lei C,Liu M,et al. Influence of end-stage renal disease on hematoma volume and intraventricular hemorrhage in patients with intracerebral hemorrhage:a cohort study and meta-analysis.[J].European Neurology,2016,75(2):33-40.
[16]何晓云.大骨瓣开颅血肿清除术、小骨窗显微血肿清除术和钻孔血肿抽吸引流术治疗高血压脑出血临床疗效对比观察[J].临床和实验医学杂志,2016,15(16):1612-1614.
[17]Huh J,Yang SY,Huh HY,et al.Compare the intracranial pressure trend after the decompressive craniectomy between massive intracerebral hemorrhagic and major ischemic stroke patients[J].Journal of Korean Neurosurgical Society,2018,61(1):42-45.
[18]张超勇,滑祥廷,李佳.锥颅血肿抽吸引流术与常规内科疗法治疗基底节区脑出血的疗效比较[J].实用临床医药杂志,2016,20(7):129-130.
[19]Hulou MM,Abdelbarr MM,Gormley WB,et al. The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle.[J]. British Journal of Neurosurgery,2016,30(4):438-443.
[20]谭支强.CT引导立体定向血肿抽吸术与保守治疗对基底节区高血压性脑出血患者的临床疗效分析[J].实用临床医药杂志,2017,21(5):113-114.
[21]Gerner ST,Kuramatsu JB,Sembill JA,et al.Association of prothrombin complex concentrate administration and hematoma enlargement in non-vitamin K antagonist oral anticoagulant-related intracerebral hemorrhage[J].Annals of Neurology,2018,83(1):186-196.
[22]杨学,陈劲草,张雪梅.小骨窗开颅与立体定向置管抽吸治疗基底节区高血压脑出血的临床研究[J].中西医结合心脑血管病杂志,2016,14(13):1472-1474.