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经额血肿穿刺引流术治疗基底节脑出血手术时机探讨

王雪原1,2,杨树源3,黄楹1,孙梅1,卓杰1,高满1   

  1. 1. 天津市环湖医院
    2. 天津医科大学研究生院
    3. 天津医科大学总医院
  • 收稿日期:2011-01-05 修回日期:2011-05-12 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 杨树源

Clinical Research about Time Window of Puncture and Drainage of Spontaneous Basal Ganglia Hemorrhage through Frontal Approach

  • Received:2011-01-05 Revised:2011-05-12 Published:2011-12-15 Online:2011-12-15
  • Contact: Shuyuan YANG

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2013

摘要： 目的：探讨不同手术时机经额血肿穿刺引流术治疗自发性基底节脑出血的疗效及对脑水肿的影响。方法：113例自发性基底节脑出血患者，根据发病后手术时机不同分为超早期组（<6 h）31例、早期组（6~24 h）42例和延期组（>24~72 h）40例。比较3组术后常见并发症的发生率、血肿清除率、脑水肿体积变化、神经功能缺损评分（NIHSS）变化及远期疗效的差异。结果：3组术后常见并发症的发生率、残余血肿体积、血肿清除率和初始脑水肿体积比较差异无统计学意义；发病后7 d脑水肿体积超早期组（6.6±4.8）mL和早期组（8.2±5.9）mL明显小于延期组（15.8±15.4）mL（均P<0.01）；手术前后NIHSS改善超早期组（11.3±6.0）分和早期组（12.5±6.3）分明显高于延期组（6.3±5.4）分（均P<0.01）。治疗后6个月ADL评分超早期组和早期组优于延期组（均P<0.01），但前2组间差异无统计学意义。结论：经额血肿穿刺引流术治疗可以有效清除血肿，早期手术能够减轻术后灶周水肿的程度并有利于患者神经功能恢复，再出血概率可能更小。

关键词: 脑血管基底神经节出血, 引流术, 脑水肿, 颅内出血, 高血压性, 尿纤溶酶原激活物, 图像处理, 计算机辅助

Abstract: Objective: To investigate the clinical efficacy of puncture and drainage for the treatment of spontaneous basal ganglia hematoma through a catheter at frontal region at different time window and its impact on brain edema. Methods: A total of 113 patients with spontaneous basal ganglia hematoma were divided into an ultra-early group （n=31, surgery started within 6 hours of the ictus），an early group （n=42, surgery started from 6 hours to 24 hours of the ictus） and a delayed group （n=40, surgery started from >24 hours to 72 hours of the ictus） according to the time window of surgery. The differences in incidence of common complications, the evacuation rate of blood clots, brain edema volume change, and neurological deficit scores （NIHSS） change and long-term follow-up results were compared among the three groups. Results: There were no significant differences in the incidence of common complications, residual hematoma volume, evacuation rate of blood clots and initial brain edema volume among the three groups. 7 days after the ictus perihematomal edema volume was （6.6±4.8） mL and （8.2±5.9） mL in the ultra-early and early groups, respectively. Both volumes were significantly lower than （15.8±15.4） mL in the delayed group （P<0.01）. The neurological deficit score （NIHSS） change was （11.3±6.0） and （12.5±6.3） in the ultra-early and early groups, respectively. Both changes were significantly higher than （6.3±5.4） in the delayed group （P<0.01）. Six months later, the ADL score in ultra-early and early groups was significantly more favorable than the delayed group （P<0.01）. But there were no significant differences between the ultra-early and early groups in these variables. Conclusion: The puncture and drainage through a catheter at frontal region for the treatment of spontaneous basal ganglia hematoma could remove blood clot effectively. Early surgery could alleviate the degree of perihematomal edema, improve neurological outcome and reduce the possibility of rebleeding.

Key words: 计算机辅助