不同时间窗微创穿刺引流术治疗高血压脑出血的疗效及安全性分析  

Efficacy and safety of minimally invasive puncture and drainage for hypertensive cerebral hemorrhage at different time windows

作　　者：胡佳[1] 薛昆[1] 王广斌[1] 孔令伟 刘建辉[1] Hu Jia;Xue Kun;Wang Guangbin;Kong Lingwei;Liu Jianhui(Department of Neurosurgery,Yantaishan Hospital,Yantai 264001,China)

机构地区：[1]烟台市烟台山医院神经外科,264001

出　　处：《中华神经医学杂志》2020年第12期1235-1239,共5页Chinese Journal of Neuromedicine

摘　　要：目的比较不同时间窗微创穿刺引流术治疗高血压脑出血的疗效和安全性。方法选择烟台市烟台山医院神经外科自2016年1月至2019年12月行微创穿刺引流术治疗的98例高血压脑出血患者,按手术时间分为超早期组(发病<3 h内手术)、早期组(发病3~24 h内手术)、急性期组(发病24~72 h内手术),回顾性分析患者的临床资料,比较3组患者的血肿清除情况、术后14 d肌力和意识改善情况、美国国立卫生研究院卒中量表(NIHSS)评分和再出血情况。结果超早期组中低、中等、高血肿清除率患者分别为11例(84.6%)、2例(15.4%)、0例。早期组中低、中等、高血肿清除率患者分别为20例(33.9%)、32例(54.2%)、7例(11.9%)。急性期组中低、中等、高血肿清除率患者分别为8例(30.8%)、14例(53.8%)、4例(15.4%)。早期组及急性期组患者的血肿清除情况较超早期组患者好。术后14 d,早期组及急性期组患者中肌力改善者所占比例高于超早期组,早期组患者中意识改善者所占比例高于超早期组及急性期组,早期组患者的NIHSS评分较超早期组及急性期组患者明显降低,差异均有统计学意义(P<0.05)。术后再出血患者共4例,其中超早期组1例,早期组3例。结论脑出血患者在发病3~24 h行微创穿刺引流术治疗时血肿清除情况较为理想,术后恢复相对较好。Objective To compare the efficacy and safety of minimally invasive puncture and drainage for hypertensive cerebral hemorrhage at different time windows.Methods A total of 98 patients with spontaneous cerebral hemorrhage underwent minimally invasive puncture and drainage in our hospital from January 2016 to December 2019 were chosen.These patients were divided into 3 groups in accordance with operation time:an ultra-early-stage group(accepted surgery within3 h of onset),an early-stage group(accepted surgery within 3-24 h of onset),an acute-stage group(accepted surgery within 24-72 h of onset);the clinical data of these patients were retrospectively analyzed.The hematoma clearance,muscle strength improvement 14 d after surgery,consciousness improvement 14 d after surgery,National Institutes of Health Neurological Deficit Scale(NIHSS)scores 14 d after surgery,and re-hemorrhage were compared among the 3 groups.Results In the ultra-early-stage group,there were 11 patients(84.6%),2 patients(15.4%)and 0 patients(0%)with low,medium and high hematoma clearance rates.In the early-stage group,there were 20 patients(33.9%),32 patients(54.2%)and 7 patients(11.9%)with low,medium and high hematoma clearance rates.In the acute-stage group,8 patients(30.8%),14 patients(53.8%)and 4 patients(15.4%)had low,medium and high hematoma clearance rates.The hematoma clearance rate in the early group and the acute group was higher than that in the ultra-early group.Fourteen d after surgery,the proportion of patients with muscle strength improvement in the early-stage group and acute-stage group was significantly higher than that in the ultra-early-stage group(P<0.05);the proportion of patients with consciousness improvement in the early-stage group was significantly higher than that in the ultra-early-stage group and acute-stage group(P<0.05);NIHSS scores of patients in the early-stage group were significantly lower than those in the ultra-early stage group and acute-stage group(P<0.05).There were 4 patients with postoperative re-hemorrhage

关 键 词：脑出血 微创穿刺引流术 时间窗 

分 类 号：R651.12[医药卫生—外科学]