高血压相关性脑干出血的个体化微创外科治疗探讨  

Discussion on individualized and minimally invasive surgical treatment of hypertension-related brainstem hemorrhage

作　　者：龙勇[1] 曾春[1] 石海平[1] 张施远[1] 廖进[1] 李维民[1] LONG Yong;ZENG Chun;SHI Hai-ping;ZHANG Shi-yuan;LIAO Jin;LI Wei-ming(Department of Neurosurgery,Suining Central Hospital,Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院神经外科,四川遂宁629000

出　　处：《实用医院临床杂志》2020年第2期234-237,共4页Practical Journal of Clinical Medicine

基　　金：四川省遂宁市市级科研基金资助项目(编号:2016y18)。

摘　　要：目的探讨个体化微创外科治疗高血压相关性脑干出血的治疗策略和疗效。方法选择2016年1月至2018年12月我院收治的48例高血压相关性脑干出血患者,其中常规内科保守治疗28例(观察组),根据三维头颅CT个体化选择手术入路全麻下微创外科手术治疗20例(治疗组),比较两组脑干出血患者的死亡率、住院时间、4周GOS评分、并发症、6个月后Barthel指数评分等治疗效果。结果治疗组死亡率(25.0%)低于观察组(57.1%),住院时间少于观察组,4周GOS评分高于观察组,并发症发生率(28.0%)明显低于观察组(42.1%)。6月后Barthel指数评分观察组>60分1例,60~40分2例,<40分9例;治疗组>60分3例,60~40分7例,<40分5例,两组比较差异有统计学意义(P<0.05)。结论高血压相关性脑干出血患者根据三维头颅CT个体化选择手术入路微创外科手术治疗,能有效降低死亡率,提高患者生活质量。Objective To explore the treatment indications and strategies of individualized minimally invasive surgery for hypertension-related brainstem hemorrhage.Methods We selected 48 patients with hypertension-associated brainstem hemorrhage who met the inclusion criteria from January 2016 to December 2018 in our hospital.Of the patients,28 patients(observation group)were treated with conventional conservative medical treatment and 20 patients(treatment group)were treated with minimally invasive surgical approach under general anesthesia based on individualized three-dimensional cranial CT.The mortality,length of hospital stay,GOS score at 4 weeks,complications and Barthel index score at 6 months were compared between the two groups.Results The mortality of the treatment group(25.0%)was lower than that of the observation group(57.1%),the hospitalization time was shorter than that of the observation group,the GOS score at 4 weeks was higher than that of the observation group,and the incidence of complications(28.0%)was significantly lower than that of the observation group(42.1%).After 6 months,there was one case with Barthel index score>60,two cases with score from 40 to 60,and 9 cases with score<40 in the observation group while there were three cases with the score>60,seven cases with the score from 40 to 60 and cases with the score<40.The difference between the two groups was statistically significant(P<0.05).Conclusion Minimally invasive surgical treatment of hypertensive-related brainstem hemorrhage can effectively reduce the mortality and improve the quality of life of patients by individualized selection of surgical approaches based on three-dimensional cranial CT.

关 键 词：高血压 脑干出血 微创治疗 

分 类 号：R651.12[医药卫生—外科学]