超早期与早期微创手术治疗中等量基底节区高血压性脑出血的疗效比较  

Comparison of the Efficacy of Ultra Early and Early Minimally Invasive Surgery in Treatment of Moderate Basal Ganglia Hypertensive Intracerebral Hemorrhage

作　　者：刘金辉[1] 王忠安[1] 龚光辉[1] 廖昆[1] 岑武[1] 李娟[2] 龚明[1] Liu Jinhui;Wang Zhongan;Gong Guanghui(Department of Neurosurgery, Xingyi People’s Hospital of Guizhou Province, Xingyi 562400, China)

机构地区：[1]贵州省兴义市人民医院神经外科,兴义562400 [2]贵州省兴义市人民医院医用氧舱科,兴义562400

出　　处：《中国微创外科杂志》2021年第2期117-120,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较超早期和早期微创手术治疗中等量基底节区高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)的疗效。方法回顾性分析2018年1月~2020年1月立体定向微创手术治疗118例中等量基底节区HICH的临床资料,其中超早期组63例(发病至手术时间<6 h),早期组55例(发病至手术时间6~24 h),随访6个月。比较2组术后1周格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、术后30 d血肿完全清除率、术后30 d内并发症及术后6个月日常生活活动能力(activity of daily living,ADL)分级。结果与早期组相比,超早期组术后1周GCS评分高[(12.97±1.38)分vs.(10.42±1.11)分,t=10.954,P=0.000],术后30 d血肿完全清除率高[95.2%(60/63)vs.76.4%(42/55),χ^2=8.925,P=0.003],术后30 d内并发症发生率低[12.7%(8/63)vs.30.9%(17/55),χ^2=5.832,P=0.016],术后30 d内死亡率低[1.6%(1/63)vs.12.7%(7/55),χ^2=4.138,P=0.042],术后6个月ADL分级好(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级分别为13、34、11、4、0例vs.6、16、8、14、4例,Z=-3.441,P=0.001)。结论超早期微创手术治疗中等量基底节区HICH疗效优于早期手术,值得推广应用。Objective To compare the efficacy of ultra early and early minimally invasive treatment of moderate hypertensive intracerebral hemorrhage(HICH)in basal ganglia.Methods Clinical data of 118 moderate basal ganglia HICH patients treated with stereotactic minimally invasive surgery form January 2018 to January 2020 were retrospectively analyzed,including 63 cases in ultra early group(time from onset to operation<6 h)and 55 cases in early group(time from onset to operation 6-24 h).All the patients were followed up for 6 months.The Glasgow Coma Scale(GCS)scores 1 week after surgery,complete hematoma clearance rate,complications within 30 days after surgery and activity of daily living(ADL)grading at 6 months after surgery were compared between the two groups.Results Compared with the early group,the GCS score one week after surgery of the ultra early group was higher[(12.97±1.38)points vs.(10.42±1.11)points,t=10.954,P=0.000],the complete hematoma clearance rate was higher[95.2%(60/63)vs.76.4%(42/55),χ^2=8.925,P=0.003],the incidence of complications within 30 days after surgery was lower[12.7%(8/63)vs.30.9%(17/55),χ^2=5.832,P=0.016],the mortality within 30 days after surgery was lower[1.6%(1/63)vs.12.7%(7/55),χ^2=4.138,P=0.042],and the ADL physical performance at 6 months after surgery was better(gradeⅠ,Ⅱ,Ⅲ,Ⅳ,andⅤ:13,34,11,4,and 0 cases vs.6,16,8,14,and 4 cases,Z=-3.441,P=0.001).Conclusion Ultra early minimally invasive surgery is superior to early surgery in the treatment of moderate basal ganglia HICH,which is worthy of promotion and application.

关 键 词：立体定向手术 超早期 微创手术 基底节区 高血压性脑出血 

分 类 号：R65[医药卫生—外科学]