立体定向血肿清除术与保守治疗对幕上中等量高血压脑出血的疗效比较  

Comparison of stereotactic and conservative treatment of supratentorial hypertensive intracerebral hemorrhage

作　　者：马倩 郭新涛 陈飞 李昆 牛玉林 Ma Qian;Guo Xintao;Chen Fei;Li Kun;Niu Yulin(Guizhou Medical University,Guiyang 550000,China)

机构地区：[1]贵州医科大学,贵阳550000

出　　处：《中国实用医刊》2019年第22期30-33,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较立体定向血肿清除术与保守治疗对幕上中等量高血压脑出血(HICH)的疗效.方法选取2017年1月至2018年7月贵州医科大学附属医院急诊神经外科收治的HICH患者153例,幕上出血25~40 ml,回顾性分析其临床资料.153例中行立体定向血肿清除术90例(微创手术组),行保守治疗63例(保守治疗组).随访6个月,比较两组患者并发症及恢复情况.结果微创手术组肺炎、低蛋白血症、下肢深静脉血栓发生率低于保守治疗组(P<0.05),脓毒血症发生率、术后6个月病死率两组比较差异未见统计学意义(P>0.05).微创手术组血肿清除时间、住院时间少于保守治疗组(P<0.05),下床活动早于保守治疗组(P<0.05);微创手术组6个月mRS评分低于保守治疗组(P<0.05),6个月ADL分级两两比较,微创手术组I~Ⅱ级较Ⅲ级比(76/9)多于保守治疗组(P<0.05);Ⅰ~Ⅱ级、Ⅲ级分别较Ⅳ~V级比,微创手术组与保守治疗组比较差异未见统计学意义(P>0.05).结论立体定向血肿清除微创术治疗HICH较保守治疗并发症少,血肿清除快,受损功能恢复早,可提高患者日常生活能力.Objective To compare the effects of stereotactic hematoma evacuation and conservative treatment on the moderate amount of supratentorial hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 153 patients with HICH who had 25 to 40 ml of supratentorial hemorrhage were selected,including 90 cases of minimally invasive surgery(minimally invasive surgery group)and 63 cases of non-surgical treatment(conservative treatment group).The patients were followed up for 6 months.The complications and recovery were compared between the two groups.Results The incidence of pneumonia,hypoproteinemia and deep venous thrombosis in the minimally invasive surgery group was lower than that in the conservative treatment group(P<0.05).The difference in the incidence of sepsis and the 6-month mortality rate was not significant between the two groups(P>0.05).The time of hematoma clearance and hospitalization in the minimally invasive surgery group were less than those in the conservative treatment group(P<0.05),and the time of off-bed activity was earlier than the conservative treatment group(P<0.05).The 6-month modified Rankin scale score in the minimally invasive surgery group was lower than that in the conservative treatment group(P<0.05).The 6-month activities of daily living grade was compared in two groups.The ratio of ADL gradeⅠtoⅡto gradeⅢwas 76/9 in the minimally invasive surgery group,bigger than that in the conservative treatment group(P<0.05).There was no significant difference in ratio of gradeⅠandⅡto gradeⅣandⅤor ratio of gradeⅢto gradeⅣandⅤbetween the minimally invasive surgery group and the conservative treatment group(P>0.05).Conclusions The minimally invasive surgery for stereotactic hematoma removal has less complications than conservative treatment.The hematoma is cleared quickly and the damaged function is restored in early by the treatment.And it can improve the daily living ability of patients.

关 键 词：高血压 脑出血 立体定向 保守治疗 

分 类 号：R651.1[医药卫生—外科学]