微创穿刺引流术治疗幕上老年大容积脑出血疗效观察  

Efficacy of minimally invasive puncture and drainage in the treatment of elderly patients with supratentorial large volume intracerebral hemorrhage

作　　者：付怀栋 刘敏华[2] FU Huai-dong;LIU Min-hua(Department of Critical Care Medicine,Huishan Traditional Chinese Medicine Hospital,Wuxi 214177,Jiangsu,CHINA;Department of Critical Care Medicine,People's Hospital of Guanyun County,Lianyungang 222200,Jiangsu,CHINA)

机构地区：[1]无锡市惠山区中医医院重症医学科,江苏无锡214177 [2]灌云县人民医院重症医学科,江苏连云港222200

出　　处：《海南医学》2020年第2期203-206,共4页Hainan Medical Journal

摘　　要：目的观察微创穿刺引流术(MIPD)治疗幕上老年大容积脑出血(ICH)的临床疗效。方法回顾性分析2016年1月至2018年12月在灌云县人民医院重症病房住院的92例幕上老年大容积ICH患者的临床资料,按治疗方法不同分为对照组44例和观察组48例,对照组接受内科治疗,观察组接受MIPD治疗和内科治疗。比较两组患者入院第1、7、21天时的血肿、血肿周围低密度区体积、美国国立卫生研究院卒中量表(NIHSS)评分,比较两组患者治疗后6个月的预后和住院期间并发症发生情况。结果治疗第7天,观察组患者的血肿体积为(10.66±4.36)cm^3,较对照组的(38.54±10.23)cm^3明显减少,血肿周围低密度区体积为(17.97±5.43)cm^3,明显低于对照组的(23.15±6.37)cm^3,NIHSS评分为(12.58±3.17)分,明显低于对照组的(15.41±2.62)分,差异均有统计学意义(P<0.05);治疗第21天,观察组患者的血肿体积为(5.75±2.79)cm^3,较对照组的(26.64±6.18)cm^3明显减少,血肿周围低密度区体积为(9.23±3.56)cm^3,明显低于对照组的(17.81±5.55)cm^3,NIHSS评分为(8.75±2.40)分,明显低于对照组的(13.05±3.48)分,差异均有统计学意义(P<0.05);治疗后6个月,观察组患者的累积病死率、改良Rankin量表(mRs)评分和预后不良发生率分别为18.8%、(3.17±1.45)分、29.2%,明显低于对照组的38.6%、(4.32±1.47)分、63.6%,差异均有统计学意义(P<0.05);观察组患者的卒中相关性肺炎(SAP)、中枢性高热、应激相关性黏膜病变伴胃肠道出血(SRMD)、急性肾损伤的发生率分别为27.1%、29.2%、25.0%、6.3%,明显低于对照组的47.7%、50.0%、47.7%、20.5%,差异均有统计学意义(P<0.05)。结论幕上老年大容积ICH应用MIPD治疗,能够加快血肿清除,减轻脑水肿,改善神经功能缺失症状,降低并发症的发生率,改善预后。Objective To observe the efficacy of minimally invasive puncture and drainage(MIPD) in the treatment of elderly patients with supratentorial large volume intracerebral hemorrhage(ICH). Methods Retrospective analysis was performed on the clinical data of 92 elderly patients with large volume ICH in the Department of Critical Care Medicine, People’s Hospital of Guanyun County from January 2016 to December 2018. According to different treatment methods, the patients were divided into control group(44 patients) and observation group(48 patients). Patients in the control group were given medical treatment only, while those in the observation group were treated by MIPD and medical treatment. The volume of hematomas, volume of perihematomal low-density area, and the National Institutes Of Health Stroke Scale(NIHSS) score were compared between the two groups at day 1, 7 and 21 of admission. The prognosis at 6 months after treatment and the incidence of complication during hospitalization were compared between the two groups. Results On the 7 thday of treatment, the volume of hematoma in the observation group was(10.66±4.36) cm^3,significantly lower than(38.54±10.23) cm^3 in the control group(P<0.05);the volume of perihematomal low-density area in the observation group was(17.97±5.43) cm^3, significantly lower than(23.15±6.37) cm^3 in the control group(P<0.05);NIHSS score in the observation group was(12.58±3.17) points, significantly lower than(15.41±2.62) points in the control group(P<0.05). On the 21 stday of treatment, the volume of hematoma in the observation group was(5.75±2.79) cm^3, significantly lower than(26.64±6.18) cm^3 in the control group(P<0.05);the volume of perihematomal low-density area in the observation group was(9.23±3.56) cm^3, significantly lower than(17.81±5.55) cm^3 in control group(P<0.05);NIHSS score in the observation group was(8.75±2.40) points, significantly lower than(13.05±3.48) points in the control group(P<0.05). Six months after treatment, the cumulative mortality, the modif

关 键 词：大容积脑出血 微创穿刺清除术 血肿周围低密度区 神经功能缺失评分 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学]