微创穿刺术治疗基底节区脑出血最佳手术时机  

A randomized clinical study on the most optimal time window of minimally invasive craniopuncture for cerebral hemorrhage in basal ganglia region

作　　者：刘红梅[1] 王文志[1] 李涤[1] 

机构地区：[1]全国脑血管病防治研究办公室,北京100050

出　　处：《中国现代神经疾病杂志》2009年第5期439-444,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：卫生部科学研究基金资助项目(项目编号:wsbkyjj2002-2-008)

摘　　要：目的探讨微创穿刺术治疗基底节区脑出血(30～50 ml)的最佳手术时机。方法采用多中心随机对照临床试验方法,纳入50家研究单位529例基底节区脑出血患者,共分为≤6 h组、>6～12 h组、>12～18 h组和>18～24 h组,分别于治疗14 d和3个月时评价4组患者神经功能、日常生活活动能力,以及住院期间和治疗3个月时病死率。结果最终进入本研究者共计507例患者,治疗14 d时神经功能和日常生活活动能力以及治疗3个月时改良Rankin量表评分,组间差异均无统计学意义(P>0.05);治疗3个月时Barthel指数,组间差异具有统计学意义(x^2=21.699,P=0.041)。线性趋势检验显示,手术时间越早,患者恢复日常生活活动能力的概率越大(trend x^2=5.624,P=0.018)。住院期间和治疗3个月时,4组患者病死率和并发症发生率差异均无统计学意义(P>0.05)。结论尽管基底节区脑出血后,各组患者施行微创穿刺术时间与神经功能改善程度、病死率和并发症发生率之间差异无统计学意义,但脑出血>24 h后患者血肿扩大、病情加重概率明显升高。因此,最佳手术时机为发病6 h内。Objective To evaluate the most optimal time window of minimally invasive craniopuneture for cerebral hemorrhage （30-50 ml） in basal ganglia region. Methods In a multi-center, randomized controlled trial （RCT）, 529 cases of cerebral hemorrhage in basal ganglia region randomly selected from 50 hospitals were enrolled. According to the protocol standard, 22 cases were excluded. The patients （n = 507） were divided into 4 groups by different time windows of minimally invasive craniopuncture after cerebral hemorrhage： ≤ 6 h group （group 1, n = 128）, 〉 6-12 h group （group 2, n = 129）, 〉 12-18 h group （group 3, n = 127） and 〉 18-24 h group （group 4, n = 123）. The neurological impairment degree and activities of daily living （ADL） of the 14th day and the end of the 3rd month after treatment, the fatality and 3 month- mortality were evaluated. Results In comparison among groups, there were no significant differences of neurofunction and ADL improvement at thc 14th day after treatment, and there were also no significant differences of modified Rankin Scale （mRS） score at the end of the 3rd month after treatment （P 〉 0.05, for all）. However, after 3 months of treatment there was significant difference of Barthel Index （BI） among groups （X2= 21.699, P=0.041）. The linear trend test indicated that the recovery probability of ADL was higher as the treatment given more earlier （trend X2 = 5.624, P = 0.018）. In comparison of the 4 groups, no significant differences in fatality and complication incidence were seen during hospitalization and the 3 month-treatment （P 〉 0.05, for all）. Conclusion Although there are no remarkable differences in the improvement of neurological function, fatality and complication incidence at different time windows of minimally invasive craniopuncture after cerebral hemorrhage in basal ganglia region, hematoma enlargement will probably occur after 〉 24 h of cerebral hemorrhage and will exacerbate the patient＇s condition. Therefore,

关 键 词：外科手术 微创性 穿刺术 脑出血 基底神经节 随机对照试验 

分 类 号：R651.1[医药卫生—外科学]