立体定向手术抽吸对脑出血伴发脑水肿治疗的临床应用研究  

Effect of stereotactic aspiration surgery for patients with cerebral edema associated with cerebral hemorrhage

作　　者：姜子荣[1] 

机构地区：[1]山东省昌邑市人民医院神经外科,山东昌邑261300

出　　处：《现代预防医学》2012年第23期6329-6330,共2页Modern Preventive Medicine

摘　　要：目的探讨立体定向手术抽吸联合尿激酶引流治疗高血压脑出血伴发脑水肿的疗效。方法选择2009年10月～2011年10月高血压脑出血伴发脑水肿患者116例为研究对象,按照随机数字表法将患者随机分为立体定向手术组(n=58)和保守治疗组(n=58)。立体定向手术组患者在三维立体定向下行血肿抽吸术,同时注入尿激酶50kU进行引流;保守治疗组给予降压、降颅压、营养神经、改善脑代谢等药物治疗。比较两组治疗后1、2、4周血肿周边水肿消散情况及临床神经功能缺损程度评分。结果治疗后1、2、4周血肿周边水肿体积立体定向手术组分别为(8.9±1.8)、(7.1±1.6)、(5.6±0.9)ml,保守治疗组分别为(16.6±2.8)、(14.9±1.8)、(6.6±1.2)ml,治疗后1、2周两组比较差异有统计学意义(P﹤0.05),而治疗后4周两组比较差异无统计学意义(P﹥0.05)。治疗后1、2、4周神经功能缺损程度评分立体定向手术组明显低于保守治疗组,差异有统计学意义(P﹤0.05)。结论立体定向手术抽吸联合尿激酶引流治疗脑出血伴发脑水肿可明显减轻早期血肿周边水肿,而且有利于改善患者的预后,提高患者的生活质量。OBJECTIVE To investigate the effect of stereotactic aspiration surgery combined with urokinase drainage for hypertensive intracerebral hemorrhage drainage associated with cerebral edema. METHODS One hundred and sixteen patients with hypertensive intracerebral hemorrhage associated with cerebral edema from October 2009 to October 2011 were randomly divided into stereotactic surgery group （n = 58） and conservative treatment group （n = 58） according to a random number table. The patients in stereotactic surgery group were assigned to be treated by three-dimensional stereotactic hematoma aspiration, and urokinase 50 kU for drainage; while the patients in the conservative treatment group were treated by conventional medical methods of decreasing blood pressure, lowering intracranial pressure, improving cerebral metabolism and neurotrophy and so on. The volume of hematoma and surrounding edema and Glasgow Outcome Scale （GOS） were compared at 1-week, 2-week, 4-week after treatment. GOS Ⅳ-Ⅴ grade was a indicator of good prognosis. RESULTS The volumes of peripheral edema at 1-week, 2-week, 4-week after treatment were （8.9±1.8）, （7.1±1.6）, （5.6±0.9） ml in stereotactic surgery group, respectively, and （16.6±2.8）, （14.9±1.8）, （6.6±1.2） ml in the conservative treatment group, respectively. the difference was statistically significant at 1-week, 2-week after treatment （P﹤0.05）, and the difference was not statistically significant at 4week after treatment （P﹥0.05）. At 2-week and 4-week after treatment, patients with good prognosis in stereotactic surgery group were significantly more than those in the conservative treatment group, and the difference was statistically significant （P ﹤0.05）. CONCLUSION Stereotactic surgery combined urokinase suction drainage can significantly reduce early hematoma surrounding edema, help improve the prognosis, and improve the quality of life in the treatment of cerebral edema associated with cerebral hemorrhage.

关 键 词：脑出血 脑水肿 立体定向 保守治疗 

分 类 号：R743.34[医药卫生—神经病学与精神病学]