抗血栓药物致脑出血的立体定向血肿抽吸治疗  

Stereotactic aspiration of hematoma in cerebral hemorrhage induced by antithrombotic drugs

作　　者：张文高[1] 杨学军[1] 高松[1] 纪延伟[1] 王雷波[2] 王增光[1] 杨卫东[1] 赵雅度(点评)[3] 

机构地区：[1]天津医科大学总医院神经外科,300052 [2]天津市海河医院脑系科 [3]北京市神经外科研究所

出　　处：《中国现代神经疾病杂志》2009年第1期55-59,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨立体定向血肿抽吸术联合药物治疗在抗血栓药物致脑出血患者治疗中的应用及疗效，以为临床提供更为合理的治疗方案。方法24例抗血栓药物致脑出血患者，12例经立体定向血肿抽吸术联合药物治疗（联合治疗组），其余12例单纯予以药物治疗（对照组）；分别采用Barthel指数评分和GOS预后分级对生存者日常生活活动能力和预后进行评价。结果联合治疗组患者颅内血肿明显缩小，其中治疗后3d血肿基本清除者5例，治疗后5d血肿清除者6例，治疗后7d血肿清除者1例；而对照组治疗后3d无一例血肿缩小，头部CT检查显示血肿周围呈低密度改变。发病后6个月，联合治疗组和对照组患者Barthel指数评分分别为（60．42±39．40）分和（29．58±32．01）分，两组日常生活活动能力比较差异具有统计学意义（t=2．104，P=0．047）；联合治疗组患者GOS预后分级达满意者7例（7／12），对照组2例（2／12），两组比较差异具有统计学意义（P=0．045）；联合治疗组死亡2例（2／12），而对照组死亡4例（4／12）。结论在病情严重程度相似的情况下，立体定向血肿抽吸术联合药物治疗的临床效果优于单纯药物治疗。Objective To investigate the application and therapeutic effect of stereotactic aspiration combined with drug treatment in patients with cerebral hemorrhage induced by antithrombotic drugs, and to provide a more rational clinical treatment. Methods Among 24 cases with cerebral hemorrhage caused by antithrombotic drugs, 12 cases received aspiration and catheter draining under MRI stereotaxy combined with drug treatment （combined therapy group）, the other 12 patients received simple drug treatment （control group）. The patients were followed up for 6 months. The activity of daily living （ADL） and prognosis of survival patients were assessed by Barthel index （BI） score and Glasgow outcome score （GOS） at the end of the 6th month from each patient＇s onset. Results After stereotactic aspiration combined with drug treatment, the volume of intracranial hematoma in the patients were obviously reduced. Complete clearance of the hematoma was shown in 5 cases after 3 d of treatment, in 6 cases after 5 d of treatment, while in one case after 7 d of treatment. In the control group, the hematoma volume reduction was not observed in any cases of the 12 patients, except a low density appearance surrounding those hematomas. The patients were followed up for 6 months after onset. The average BI score in the combined therapy group and the control group was （60.42 ± 39.40） points and （29.58 ± 32.01） points, respectively; the inter-group difference of ADL was statistically significant （t = 2.104, P= 0.047）. In the combined therapy group, 7 cases （7/12） were satisfied with the GOS classification; while in the control group, 2 cases （2/12） were satisfied with the GOS classification. The inter-group difference was statistically significant （P= 0.045）. In the combined therapy group, 2 cases （2/12） died, while in the control group, 4 cases （4/12） died. Conclusion The effect of stereotactic aspiration combined with drug treatment is superior to simple drug treatment for the patients wit

关 键 词：脑出血 血小板聚集抑制剂 抗凝药 立体定位技术 抽吸 磁共振成像 

分 类 号：R651.12[医药卫生—外科学]