超早期微创穿刺引流术治疗高血压脑出血的临床研究
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摘要
目的:比较不同手术时机运用微创穿刺引流术治疗高血压脑出血的疗效,探讨其临床应用价值。
方法:将符合入选条件的、广西医科大学第九附属医院神经外科2007年1月至2008年10月行微创穿刺引流术治疗的59例高血压脑出血患者作为研究对象,分为超早期组(32例)和延期组(27例)进行比较研究。比较手术并发症发生率及术后近期(1个月)和远期随访(6个月)疗效。
结果:两组病例术后常见并发症发生率均无显著性差异(P＞0.05),但预后存在显著差异,超早期组病例近、远期病残率明显低于延期组(P＜0.05)。
结论:临床观察和随访表明,对于轻中度高血压脑出血(血肿量＜60ml),适合微创穿刺引流的患者,超早期手术能显著改善机能预后,降低致残率,提高生存质量。
Objective:To compare the curative effect of minimally invasive operation in treatment of hypertensive intracerebral hemorrhage in different time,and to evaluate the clinical value.
Methods:The clinical data of 59 patients suffering from hypertensive intracerebral hemorrhage who were admitted to the Nine Affiliated Hospital of Guang xi Medical University from January 2007 to October 2008 were be researched.They were divided into two groups:super-early group(32case) and delay group(27case).Super-early group was compared with the delay group, from which,the difference in intercurrent-symptom rate、current(1month) and last(6months) curative effect between the two groups were concluded.
Result:Intercurrent-symptom rate of two groups was of no significant statistical difference(P＞0.05),but current and last disability rate of super-early group was obvious lower than those of delay group(P＜0.05).
Conclusion:Clinical research and follow visitation indicate that therapeutic effect of super-early group was much better than delay group for patients with hematoma less than 60ml,the super-early mini-invasion operation can improve prognosis and decrease the rate of disability,enhance survival quality.
方法:将符合入选条件的、广西医科大学第九附属医院神经外科2007年1月至2008年10月行微创穿刺引流术治疗的59例高血压脑出血患者作为研究对象,分为超早期组(32例)和延期组(27例)进行比较研究。比较手术并发症发生率及术后近期(1个月)和远期随访(6个月)疗效。
结果:两组病例术后常见并发症发生率均无显著性差异(P＞0.05),但预后存在显著差异,超早期组病例近、远期病残率明显低于延期组(P＜0.05)。
结论:临床观察和随访表明,对于轻中度高血压脑出血(血肿量＜60ml),适合微创穿刺引流的患者,超早期手术能显著改善机能预后,降低致残率,提高生存质量。
Objective:To compare the curative effect of minimally invasive operation in treatment of hypertensive intracerebral hemorrhage in different time,and to evaluate the clinical value.
Methods:The clinical data of 59 patients suffering from hypertensive intracerebral hemorrhage who were admitted to the Nine Affiliated Hospital of Guang xi Medical University from January 2007 to October 2008 were be researched.They were divided into two groups:super-early group(32case) and delay group(27case).Super-early group was compared with the delay group, from which,the difference in intercurrent-symptom rate、current(1month) and last(6months) curative effect between the two groups were concluded.
Result:Intercurrent-symptom rate of two groups was of no significant statistical difference(P＞0.05),but current and last disability rate of super-early group was obvious lower than those of delay group(P＜0.05).
Conclusion:Clinical research and follow visitation indicate that therapeutic effect of super-early group was much better than delay group for patients with hematoma less than 60ml,the super-early mini-invasion operation can improve prognosis and decrease the rate of disability,enhance survival quality.
引文
[1]Hall CE,Grotta JC.New era for management of primary hypertensive intracerebral hemorrhage[J].Curr Neurol Neurosic Rep,2005,5(1):29-35.
[2]吴承远,刘玉光.临床神经外科学[M].第1版.北京:人民卫生出版社,2001,530-531.
[3]周良辅.现代神经外科学[M].上海:复旦大学出版社,2001:798-799.
[4]张玉琪.再论微创神经外科学(述评)[J].中华神经外科杂志,2005,21(4):193-194.
[5]刘振川,徐立明,赵仕欣,等.微创介入颅内出血(血肿)清除术在神经内科的应用研究[J].中国临床神经科学,2000,8(2):137-138.
[6]Kaneko M,koba T.Early surgical treatment for hypertensive intracerebral hemorrhage[J].J Neurosurg,1997,46:597.
[7]王忠诚.神经外科学[M].第1版.武汉:湖北科技出版社,1998,686-689.
[8]Maira G,Anile C,Colosimo C,et al.Surgical treatment of primary supratentorial intracerebral hemorrhage in stuporous and comatose patients [J].NeurolRes,2002,24(1):54-60.
[9]Tan SH,Ng PY.Hypertensive basal ganglia hemorhage:a prospective study comparing surgical and nonsurgical management[J].Surg Neurol,2001,56(5):287-293.
[10]徐侃,黄蕾,张燕飞.微创手术治疗高血压脑出血的临床研究[J]中国神经精神疾病杂志,2001,27(6):444-446.
[11]赵继宗,季楠.脑卒中外科治疗的现状与展望[J].中华神经医学杂志,2002,1(1):1-3.
[12]陈世全,陈璐,姚维成,等.脑内血肿排空治疗的历史、现状和前景[J].中国微侵袭神经外科杂志,2000,5(9):49.
[13]Kaya RA,Turkmenoglu O,Ziyal IM,Dalkilic T,et al.The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvia transinsular approach[J].Surgical Neurology,2003,59;176-183.
[14]张延平,张攀,李业生.高血压脑出血继发重型脑室内出血的微创手术治疗(附169例报告)[J].中国微侵袭神经外科杂志,2006,11:84-85.
[15]李树春,赵振华.微创手术治疗高血压脑出血临床分析[J].中国现代神经疾病杂志,2005,5:171.
[16]李金彩,李中秋,陆兵勋,等.脑立体定向微创手术治疗高血压脑出血[J].中华神经医学杂志,2006,5:855-856.
[17]潘建华.超早期小骨窗微创手术治疗高血压脑出血21例临床分析.河北医学,2005,11(10):879-881.
[18]夏鹰,陈衔城,季耀东,等.脑出血血肿周围脑组织的糖代谢、氧自由基及血脑屏障的变化与脑水肿形成的关系.复旦学报(医学版),2002,29(2):119-128.
[19]Lee JI,Nam do H,Kim JS,et al.Stereotactic aspiration of intracerebral haematomar significance of surgical timing and haematoma volume reduction.J Clin Neurosci,2003,10:439-443.
[20]Teemstra OP,Evers SM,Lodder I,et al.Stereotactic treatment of intracerebral hematoma by means of a plasm inogen activator a multicenter randomized controlled trial.Stroke,2003,34(4):968-974.
[21]Morgestem LB,Demchuk AM,Kim DH,et al.Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemor-rhage.Neurology,2001,56:1294-1299.
[22]张锦钊.258例高血压脑出血手术治疗临床分析.中华神经医学杂志,2003,11(2):430.
[23]刘增良,刘洋,高伟达,等.高血压脑出血超早期手术治疗疗效分析.神 经疾病与精神卫生,2005,5(2):123-124.
[24]葛峻岭,潘速跃.脑出血的手术和超早期止血治疗.国外医学脑血管疾病分册,2005,13(1):22-26.
[1]Qureshi AI,Tuhrim S,Broderick JP,Batjer HH,Hondo H,Hanley DRS pontaneous intracerebral hemorrhage[J].N Engl J Med,2001,344:1450-1460.
[2]Diringer MN.Intracerebral hemorrhage:Pathophysiology and management[J].Crit Care Med,2002,21:1591-1603.
[3]Kazui S,Naritomi H,Yamamoto H,et al.Enlargement of spontaneous incidence and time course[J].Stroke,2000,27:1783-1987.
[4]Lee KR,Kawai N,Kim S,et al.Mechanisms of edema formation after intracerebral hemorrhage:effects of thrombin on CBF,BBB.Permeability and cell survival in a rat model[J].J Neurosurg,2002,86:272-278.
[5]Kanno T,Nagata T,Nonomura K,et al.New approaches in the treatment of hypertensive intracerebral hemorrhage[J].Stroke,1993,24(Suppl I):I-96-I-100.
[6]Fernandes H,Mendelow A.Spontaneous intracerebral hemorrhage:a surgical dilemma[J].Br J Neurosurg,1999,13:389-394.
[7]王忠诚.神经外科学[M].武汉:湖北科学技术出版社,2006:866-867.
[8]Hemphillm JC,Bonovich DC,Besmertis L,et al.A simple,reliable gradingscale for intracerebral hemorrhage[J].Stroke,2001,32:891-897.
[9]刘兴波.超早期钻孔溶解血肿治疗高血压脑出血[J].中风与神经疾病杂志,1992,2:103.
[10]Kaya RA,Turkmenoglu O,Ziyal IM.Dalkilic T,et al.The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvia transinsular approach[J].Surgical Neurology,2003,59;176-183.
[11]张延平,张攀,李业生.高血压脑出血继发重型脑室内出血的微创手术治疗(附169例报告)[J].中国微侵袭神经外科杂志,2006,11:84-85.
[12]李树春,赵振华.微创手术治疗高血压脑出血临床分析[J].中国现代神经疾病杂志,2005,5:171.
[13]李金彩,李中秋,陆兵勋,等.脑立体定向微创手术治疗高血压脑出血[J].中华神经医学杂志,2006,5:855-856.
[14]LiLiang PC,CL,Lu CH,et al.Hypertensive caudate hemorrhage:outcome;and role of external ventricular drainge[J].Stroke,2001,32:1195-1200.
[15]Zhao JZ,Zhou DB,Zhou LF,et al.The efficacy of three different approaches in treatment of hypertensive mtracerebral hemorrhage:a multicenter single-blind study of 2464 patients[J].Zhonghua Yi Xue Za Zhi,2005,85;2238-2242.
[16]李云辉,林中平,黄建龙,等.超早期锁孔血肿清除术治疗高血压基底节出血[J].中国危重病急救医学,2005,17:312.
[17]胡多利,陈忠良,朱其铮.36例脑出血微创手术前后影像学变化及临床分析[J].中华临床医学杂志,2005,6:31-33.
[2]吴承远,刘玉光.临床神经外科学[M].第1版.北京:人民卫生出版社,2001,530-531.
[3]周良辅.现代神经外科学[M].上海:复旦大学出版社,2001:798-799.
[4]张玉琪.再论微创神经外科学(述评)[J].中华神经外科杂志,2005,21(4):193-194.
[5]刘振川,徐立明,赵仕欣,等.微创介入颅内出血(血肿)清除术在神经内科的应用研究[J].中国临床神经科学,2000,8(2):137-138.
[6]Kaneko M,koba T.Early surgical treatment for hypertensive intracerebral hemorrhage[J].J Neurosurg,1997,46:597.
[7]王忠诚.神经外科学[M].第1版.武汉:湖北科技出版社,1998,686-689.
[8]Maira G,Anile C,Colosimo C,et al.Surgical treatment of primary supratentorial intracerebral hemorrhage in stuporous and comatose patients [J].NeurolRes,2002,24(1):54-60.
[9]Tan SH,Ng PY.Hypertensive basal ganglia hemorhage:a prospective study comparing surgical and nonsurgical management[J].Surg Neurol,2001,56(5):287-293.
[10]徐侃,黄蕾,张燕飞.微创手术治疗高血压脑出血的临床研究[J]中国神经精神疾病杂志,2001,27(6):444-446.
[11]赵继宗,季楠.脑卒中外科治疗的现状与展望[J].中华神经医学杂志,2002,1(1):1-3.
[12]陈世全,陈璐,姚维成,等.脑内血肿排空治疗的历史、现状和前景[J].中国微侵袭神经外科杂志,2000,5(9):49.
[13]Kaya RA,Turkmenoglu O,Ziyal IM,Dalkilic T,et al.The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvia transinsular approach[J].Surgical Neurology,2003,59;176-183.
[14]张延平,张攀,李业生.高血压脑出血继发重型脑室内出血的微创手术治疗(附169例报告)[J].中国微侵袭神经外科杂志,2006,11:84-85.
[15]李树春,赵振华.微创手术治疗高血压脑出血临床分析[J].中国现代神经疾病杂志,2005,5:171.
[16]李金彩,李中秋,陆兵勋,等.脑立体定向微创手术治疗高血压脑出血[J].中华神经医学杂志,2006,5:855-856.
[17]潘建华.超早期小骨窗微创手术治疗高血压脑出血21例临床分析.河北医学,2005,11(10):879-881.
[18]夏鹰,陈衔城,季耀东,等.脑出血血肿周围脑组织的糖代谢、氧自由基及血脑屏障的变化与脑水肿形成的关系.复旦学报(医学版),2002,29(2):119-128.
[19]Lee JI,Nam do H,Kim JS,et al.Stereotactic aspiration of intracerebral haematomar significance of surgical timing and haematoma volume reduction.J Clin Neurosci,2003,10:439-443.
[20]Teemstra OP,Evers SM,Lodder I,et al.Stereotactic treatment of intracerebral hematoma by means of a plasm inogen activator a multicenter randomized controlled trial.Stroke,2003,34(4):968-974.
[21]Morgestem LB,Demchuk AM,Kim DH,et al.Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemor-rhage.Neurology,2001,56:1294-1299.
[22]张锦钊.258例高血压脑出血手术治疗临床分析.中华神经医学杂志,2003,11(2):430.
[23]刘增良,刘洋,高伟达,等.高血压脑出血超早期手术治疗疗效分析.神 经疾病与精神卫生,2005,5(2):123-124.
[24]葛峻岭,潘速跃.脑出血的手术和超早期止血治疗.国外医学脑血管疾病分册,2005,13(1):22-26.
[1]Qureshi AI,Tuhrim S,Broderick JP,Batjer HH,Hondo H,Hanley DRS pontaneous intracerebral hemorrhage[J].N Engl J Med,2001,344:1450-1460.
[2]Diringer MN.Intracerebral hemorrhage:Pathophysiology and management[J].Crit Care Med,2002,21:1591-1603.
[3]Kazui S,Naritomi H,Yamamoto H,et al.Enlargement of spontaneous incidence and time course[J].Stroke,2000,27:1783-1987.
[4]Lee KR,Kawai N,Kim S,et al.Mechanisms of edema formation after intracerebral hemorrhage:effects of thrombin on CBF,BBB.Permeability and cell survival in a rat model[J].J Neurosurg,2002,86:272-278.
[5]Kanno T,Nagata T,Nonomura K,et al.New approaches in the treatment of hypertensive intracerebral hemorrhage[J].Stroke,1993,24(Suppl I):I-96-I-100.
[6]Fernandes H,Mendelow A.Spontaneous intracerebral hemorrhage:a surgical dilemma[J].Br J Neurosurg,1999,13:389-394.
[7]王忠诚.神经外科学[M].武汉:湖北科学技术出版社,2006:866-867.
[8]Hemphillm JC,Bonovich DC,Besmertis L,et al.A simple,reliable gradingscale for intracerebral hemorrhage[J].Stroke,2001,32:891-897.
[9]刘兴波.超早期钻孔溶解血肿治疗高血压脑出血[J].中风与神经疾病杂志,1992,2:103.
[10]Kaya RA,Turkmenoglu O,Ziyal IM.Dalkilic T,et al.The effects on prognosis of surgical treatment of hypertensive putaminal hematomas through transsylvia transinsular approach[J].Surgical Neurology,2003,59;176-183.
[11]张延平,张攀,李业生.高血压脑出血继发重型脑室内出血的微创手术治疗(附169例报告)[J].中国微侵袭神经外科杂志,2006,11:84-85.
[12]李树春,赵振华.微创手术治疗高血压脑出血临床分析[J].中国现代神经疾病杂志,2005,5:171.
[13]李金彩,李中秋,陆兵勋,等.脑立体定向微创手术治疗高血压脑出血[J].中华神经医学杂志,2006,5:855-856.
[14]LiLiang PC,CL,Lu CH,et al.Hypertensive caudate hemorrhage:outcome;and role of external ventricular drainge[J].Stroke,2001,32:1195-1200.
[15]Zhao JZ,Zhou DB,Zhou LF,et al.The efficacy of three different approaches in treatment of hypertensive mtracerebral hemorrhage:a multicenter single-blind study of 2464 patients[J].Zhonghua Yi Xue Za Zhi,2005,85;2238-2242.
[16]李云辉,林中平,黄建龙,等.超早期锁孔血肿清除术治疗高血压基底节出血[J].中国危重病急救医学,2005,17:312.
[17]胡多利,陈忠良,朱其铮.36例脑出血微创手术前后影像学变化及临床分析[J].中华临床医学杂志,2005,6:31-33.