立体定向抽吸辅以尿激酶液化治疗中等量丘脑出血疗效研究  

Stereotactic aspiration in combination with urokinase thrombolytic therapy in patients with moderate thalamic hemorrhage:a controlled trial

作　　者：陈茂刚[1,2,3,4] 殷勤[1,2] 朱武生[1,2] 王启章[1,2] 黄显军[1,2] 张敏[1,2] 姜永军[1,2] 李永坤[1,2] 樊新颖[1,2] 马敏敏[1,2] 左其龙[3,4] 周仪[3,4] 黄小鹏[3,4] 徐格林[1,2] 刘新峰[1,2] 

机构地区：[1]南京大学医学临床学院 [2]南京军区南京总医院神经内科,南京210002 [3]南通大学第四附属医院 [4]盐城市第一人民医院,江苏盐城224001

出　　处：《中国实用内科杂志》2012年第9期699-703,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81070922);盐城市科技局资助课题(YK-2009116)

摘　　要：目的评价立体定向抽吸辅以尿激酶液化治疗中等量丘脑出血(10～35 mL)的临床疗效。方法将盐城市第一人民医院2006年1月至2011年6月住院的中等量丘脑出血(TH)患者137例,分为内科组68例,给予常规内科治疗;手术组69例,在常规内科治疗的基础上,采用立体定向抽吸辅以尿激酶液化清除血肿。结果手术组30 d病死率显著低于内科组(10.1%对33.8%)。手术组30 d格拉斯哥预后(GOS)评分平均秩次高于内科组(P=0.025)。在存活病例中,手术组30 d的美国国立卫生院神经功能缺损评分(NIHSS评分)显著低于内科组[(13.5±4.0)对(16.8±4.3)]。手术组在入院后第3天、第7天的血肿体积减少率分别为40.1%和63.8%,均显著高于内科组-0.21%与39.80%(P均<0.01)。10～20 mL出血患者中,手术组30 d的NIHSS评分(8.5±3.9)显著低于内科组(11.5±4.2)(P=0.023);但在30 d病死率、GOS评分方面,两组差异无统计学意义。在21～35 mL出血患者中,手术组30 d的病死率[20/44(45.5%)]显著低于内科组[6/48(12.5%)](P<0.001);手术组30 d的GOS评分的平均秩次显著高于内科组(P<0.0001);在存活病例中,手术组30 d NIHSS评分显著低于内科组(15.9±3.8对21.4±4.3)。在长期疗效方面,手术组90 d的GOS平均秩次显著高于内科组(P=0.001);手术组的转归良好(GOS>3)率为52.2%(36/69),显著高于内科组27.9%(19/68)(P=0.001);90 d的累积病死率为13.0%(9/69),显著低于内科组的36.8%(25/68)(P=0.001)。10～20 mL出血患者中,两组90 d GOS平均秩次、90 d良好转归率、90 d病死率差异均无统计学意义。在21～35 mL出血量亚组患者中,手术组90 d GOS平均秩次显著高于内科组(P=0.001);手术组的转归良好率为41.7%(20/48),显著高于内科组(13.6%,6/44)(P=0.003);90 d累积病死率为16.7%(8/48),显著低于内科组(50.0%,22/44)(P=0.001)。两组在30 d内再出血、颅内感染、肺部感染的发生率方面,差异无统计学意义。结论本研究初步显示立体定向抽吸辅�Objective To assess the efficacy of stereotactic aspiration in combination with urokinase thrombolytic therapy in patients with moderate （ 10 -35 mL） thalamic hemorrhage （TH）. Methods A total of 137 patients with moderate TH admitted to Yancheng First People＇s Hospital between January 2006 and June 2011 were assigned to receive internal medicine treatment alone （ internal medicine treatment group, n = 68 ） or in combination with stereotactic aspiration and urokinase thrombolytic therapy （ operation group, n = 69）, respectively. Results At day 30, operation group was associated with significantly lower mortality rate than that in internal medicine treatment group （ 10. 1% vs 33.8% ,P = 0. 001 ）. Higher mean ranking of Glasgow Outeome Seore （GOS） at day 30 was in favor of operation group, but not internal medicine treatment group （ P = 0. 025 ）. Of all survival eases, operation group yielded a eonsiderably reduced National Institute of Health Stroke Seale （NIHSS） than internal medicine treatment group at day 30 （ 13.5±4. 0 vs 16. 8 ±4. 3 ,P 〈0. 001 ）. Operation group was assoeiated with marked reduetion in the volume of hematoma when eompared with internal medieine treatment group at day 3 （40. 1% vs -0. 21% ,P 〈0. 01 ） and day 7 （63.8% vs 39. 80% ,P 〈0. 01 ）. In patients having 10 - 20 mL TH, operation group resulted in markedly declined NIHSS （ 8.5 ± 3.9 vs 11.5 ± 4. 2, P = 0. 023 ） , but not mortality or GOS at day 30. In patients with TH of 21 -35 mL, lower mortality rate （P 〈 0. 001 ） was found in operation group （20/44, 45.5% ） ,but not internal medicine treatment group （ 6/48,12. 5% ）. At day 30, operation group yielded remarkably increased mean ranking of GOS （ P 〈 0. 0001 ）. Of all survival cases, considerably reduced NIHSS was found in operation group when compared with internal medieine treatment group （ 15.9 ± 3.8 vs 21.4 ± 4. 3 ）. Regarding long-term effieaey, significantly elevated mean ranking of GOS was revealed in

关 键 词：丘脑出血 立体定向抽吸 颅内血肿微创清除术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]