两种时机立体定向手术治疗自发性脑出血的效果比较  

Effects of stereotactic surgery at two different timings on patients with spontaneous intracerebral hemorrhage

作　　者：李来兴 翟延青 乔丹丹 Li Laixing;Zhai Yanqing;Qiao Dandan(Department of Neurosurgery,Linfen Central Hospital,Linfen 041000,China)

机构地区：[1]山西省临汾市中心医院神经外科,041000

出　　处：《中国实用医刊》2020年第15期30-33,共4页Chinese Journal of Practical Medicine

摘　　要：目的:比较发病6 h内和发病6~24 h立体定向手术治疗自发性脑出血(SICH)的效果。方法:抽取2017年5月至2019年5月临汾市中心医院收治的108例SICH患者,根据手术时机分为A、B两组,每组54例。两组均行立体定向手术,A组于发病6 h内进行手术,B组于发病6~24 h内进行手术。观察两组血肿清除率、手术时间、术中出血量、卧床时间及并发症发生情况,并于术后3个月进行随访,比较预后优良率、血清caspase切割的细胞角蛋白18(CCCK-18)、核因子kappa Bp65(NF-κBp65)水平及中国脑卒中临床神经功能缺损程度评分量表(CSS)评分、日常生活能力量表(ADL)评分。结果:①A组血肿清除率[(91.46±6.05)%]高于B组[(80.67±6.83)%],卧床时间[(11.31±1.62)d]短于B组[(19.72±2.05)d],P<0.05。②两组并发症发生率比较差异未见统计学意义(P>0.05)。③术后3个月随访,A组预后优良率(66.67%,36/54)高于B组(46.30%,25/54),P<0.05。④术后3个月,A组血清CCCK-18、NF-κBp65水平低于B组(P<0.05)。术后3个月,A组CSS评分低于B组,ADL评分高于B组(P<0.05)。结论:SICH患者发病6 h内进行立体定向手术能有效提高血肿清除率,缩短卧床时间,改善预后,减轻神经功能缺损,提高日常生活能力,不增加并发症发生率。Objective To compare the effects of performing stereotactic surgery within 6 hours and between 6 and 24 hours after disease onset on patients with spontaneous intracerebral hemorrhage(SICH).Methods A total of 108 patients with SICH treated in Linfen Central Hospital from May 2017 to May 2019 were selected and divided into two groups according to the timings of surgery,with 54 cases in each group.Both groups underwent stereotactic surgery,however,group A underwent surgery within 6 hours after onset,and group B underwent surgery between 6 and 24 hours after onset.The hematoma clearance rate,operation time,intraoperative blood loss,bed time,complications in the two groups were observed.Patients were followed up for 3 months after surgery to compare the excellent prognosis rate,levels of serum caspase-cleaved cytokeratin 18(CCCK-18)and nuclear factor kappa Bp65(NF-κBp65),China stroke scale(CSS)score,and activties of daily living scale(ADL)score between the two groups.Results The hematoma clearance rate in group A was(91.46±6.05)%,higher than the(80.67±6.83)%in group B,and the bed rest time in group A was(11.31±1.62)d,shorter than the(19.72±2.05)d in group B(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).During the 3-month follow-up,the excellent prognosis rate in group A(66.67%,36/54)was higher than that in group B(46.30%,25/54),P<0.05.Levels of serum CCCK-18 and NF-κBp65 in group A were lower than those in group B 3 months after operation(P<0.05).The CSS score of group A was lower than that of group B 3 months after operation,and the ADL score was higher than that of group B(P<0.05).Conclusions Performing stereotactic surgery within 6 hours after onset for SICH patients can effectively improve the hematoma clearance rate,shorten the bed rest time,improve prognosis,reduce neurological deficits,improve daily living ability,without increase in the incidence of complications.

关 键 词：自发性脑出血 立体定向手术 手术时机 神经功能 

分 类 号：R651.12[医药卫生—外科学]