微创穿刺引流术联合阿替普酶改善老年基底节区脑出血的预后  

Minimally invasive puncture and drainage combined with Alteplase improve the outcome of elderly patients with basal ganglia intracerebral hemorrhage

作　　者：陈自光 谢宗义[2] 罗旭[2] 刘洪材[2] 黄琴[2] 陈维福[2] 马颖[2] 程远[2] 

机构地区：[1]重庆市梁平县人民医院神经科,重庆405200 [2]重庆医科大学附属第二医院神经外科,重庆400010

出　　处：《重庆医科大学学报》2016年第8期846-849,共4页Journal of Chongqing Medical University

基　　金：重庆市科委自然科学基金资助项目(编号:cstc2013jcyj A10054);重庆市卫生局医学科研计划资助项目(编号:2013-1-018)

摘　　要：目的：探讨微创穿刺引流术联合阿替普酶治疗中等量老年基底节区脑出血的临床疗效。方法：回顾性分析2010～2014年我科老年自发性基底节区脑出血96例,其中颅内血肿微创穿刺引流术联合阿替普酶治疗（微创组）50例,常规开颅血肿清除术（开颅组）46例。比较两组患者术后1月的Glasgow昏迷评分（Glasgow coma scale,GCS）、再出血率、并发症发生率、住院时间,术后1年的格拉斯哥结果评分（Glasgow outcome scale,GOS）、改良Rankin量表（modified Rankin scale,m RS）、Barthel指数（Barthel index,BI）和病死率。结果：术后1月,微创组的再出血率、并发症发生率（除消化道出血外）、住院时间均明显低于开颅组（P〈0.05）,GCS明显高于开颅组（P〈0.05）。术后1年,微创组GOS和BI均明显高于开颅组（P〈0.05）,微创组m RS低于开颅组（P〈0.05）。不过,2组病死率无统计学差异（P〉0.05）。结论：微创穿刺引流术联合阿替普酶是一种治疗老年自发性基底节区脑出血的有效手段,能降低脑出血的并发症和致残率,改善神经功能障碍,提高患者生活质量。Objective：To investigate the clinical value of minimally invasive puncture and drainage（MIPD）combined with Alteplase treatment in elderly patients with basal ganglia intracerebral hemorrhage（ICH）. Methods：A retrospective analysis was made on 96 spontaneous basal ganglia ICH cases. Fifty cases received MIPD combined with Alteplase treatment（MIPD group）and 46 cases received conventional craniotomy and evacuation of hematoma（CC group）. The Glasgow coma scale（GCS）scores,rebleeding incidences,postoperative complications（PC）,and hospital stay at one month after operation were compared between the two groups. Moreover,Glasgow outcome scale（GOS）,modified Rankin scale（m RS）,Barthel index（BI）,and case fatality（CF）at one year postoperation were assessed,respectively. Results：Compared with those of CC group,a significant decrease in rebleeding incidences,postoperative complications and hospital stay was observed in MIPD group at one month postoperation（P〈0.05）. Moreover,GCS score in MIPD group was obviously higher than that in CC group（P〈0.05）. The GOS,m RS,and BI representing long-term outcome in MIPD group were ameliorated significantly higher than that in CC group at one year postoperation（P〈0.05）. However,there was no significant difference between in CF between MIPD group and CC group（P 〉0.05）. Conclusion：MIPD combined with Alteplase therapy may be an effective treatment in elderly patients with spontaneous basal ganglia ICH,which can improve the quality of life of patients by reducing the complications and mortality and ameliorating the neurological dysfunction.

关 键 词：基底节区脑出血 微创穿刺引流术 开颅血肿清除术 阿替普酶 

分 类 号：R743.3[医药卫生—神经病学与精神病学]