穿刺术和小骨窗手术对中等量脑出血的治疗  

Comparison between microinvasive puncture and small bone window craniotomy in the treatment of moderate cerebral hemorrhage

作　　者：王文学[1] 汪军[2] 翟德忠[1] 刘宇梁[1] 石佃勤[1] 伏光辉[1] 李凤利[1] 

机构地区：[1]江苏省连云港市第一人民医院东方医院神经外科,222042 [2]湖北省公安县人民医院外科

出　　处：《中国医师进修杂志（外科版）》2009年第12期7-10,共4页Chinese Journal of Postgraduates of Medicine

基　　金：基金项目：江苏省连云港市医学重点人才项目（ZC238）

摘　　要：目的评价微创穿刺术与小骨窗开颅血肿清除术治疗中等量（30～60m1）基底节区脑出血的不同效果。方法随机将95例中等量基底节区脑出血患者分为治疗组（49例）和对照组（46例），治疗组采用微创穿刺术，对照组采用小骨窗开颅血肿清除术。评价两组术后14d时神经功能改善情况；术后14d和3个月时日常生活活动能力（ADL）恢复情况；住院期间和术后3个月时病死率及并发症发生情况。结果术后14d时，两组神经功能缺损评分（SSS）和改良Rankin量表评分（MRS）比较差异无统计学意义。治疗组住院期间的呼吸道感染、消化道出血、电解质代谢紊乱发生率[分别为16．33％（8／49）、6．12％（3／49）、6．12％（3／49）]与对照组[分别为56．52％（26／46）、21．74％（10／46）、21．74％（10／46）]比较差异有统计学意义（P〈0．05）。术后3个月时随访，两组MRS比较差异有统计学意义（P〈O．05），患者ADL达良好者（Barthel指数95～100分）治疗组为39．13％（18／46），对照组为4．65％（2／43），差异有统计学意义（，=18．7524，P=0．0009），治疗组和对照组的病死率[分别为6．12％（3／49）、6．52％（3／46）]比较差异无统计学意义。结论与小骨窗开颅血肿清除术相比，微创穿刺术可明显减少中等量（30～60m1）基底节区脑出血患者并发症的发生，可提高患者ADL，降低病残率，而且不增加病死率。Objective To evaluate and compare the curative effect between the microinvasive craniopuncture therapy and the clearance of hematoma by craniotomy with small bone flap in treating patients with moderate cerebral hemorrhage （30-60 ml）in the basal ganglion part of the brain. Methods Ninety-five patients with intracerebral hemorrhage were randomly divided into treatment group （microinvasive craniopuncture therapy） and control group （ the clearance of hematoma by craniotomy with small bone flap ）. The main indexes of evaluation were the neurological impairment degree （NID） on the 14th day after treatment, activities of daily living （ADL） by the end of the third month, the incidence rate of complications, and the case fatality during 3 months. Results On the 14th day after treatment, there was no significant difference between the two groups in the NID and the ADL of patients. The incidence rate of respiratory tract infection, gastrointestinal hemorrhage, electrolyte disorder in treatment group [ 16.33% （8/49）, 6.12% （3/49）, 6.12% （ 3/49 ）, respectively ] was significantly reduced than those of control group [ 56.52% （26/46）, 21.74% （10/46）, 21.74% （10/46 ）, respectively ] during hospitalization （P 〈 0.05 ）. By the end of the third month, there was significant difference in favorable outcomes （Barthel index 95-100）（ X2 = 18.7524,P = 0.0009） and in improving the ADL （MRS）（t = 5.2723,P = 0.0001 ） between the two groups [39.13% （18/46）, 4.65% （2/43）, respectively ]. In case fatality, there was no significant difference between the two groups [6.12% （3/49）,6.52% （3/46）,respectively]. Conclusion As compared with the clearance of hematoma by craniotomy with small bone flap, the microinvasive craniopuncture therapy can remarkably reduce the incidence of complications, and improve the ADL of patients with moderate cerebral hemorrhage （30-60 ml） in the basal ganglion, and decrease disability without increasing fatality.

关 键 词：脑出血 穿刺术 血肿 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R735[医药卫生—临床医学]