多模态3D-Slicer颅内血肿重建技术辅助神经内镜微创手术联合早期康复治疗高血压脑出血伴偏瘫患者的疗效研究  

Effectiveness Study of the Neural Endoscopic Minimally Invasive Surgery Assisted with Multimode 3D-Slicer Intracranial Hematoma Reconstruction Combined with Early Rehabilitation in Treating Hypertensive Cerebral Hemorrhage Patients Accompanied with Hemiplegia

作　　者：张利[1] 张于[2] 王彦[3] 石文建[1] 张欢[1] 董伟[1] ZHANG Li;ZHANG Yu;WANG Yan;SHI Wenjian;ZHANG Huan;DONG Wei(Department of Neurosurgery,Tangshan People's Hospital,Tangshan 063000,China;ICU,Tangshan People's Hospital,Tangshan 063000,China;Department of Neurology,Tangshan People's Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市人民医院神经外科,063000 [2]河北省唐山市人民医院ICU,063000 [3]河北省唐山市人民医院神经内科,063000

出　　处：《实用心脑肺血管病杂志》2021年第5期118-123,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：2020年唐山市科学技术研究与发展计划项目(20150205C);2020年河北省自然科学基金精准医学联合基金培育项目(H2020105017)。

摘　　要：背景目前手术是临床治疗高血压脑出血(HICH)的主要手段,但术后致残率较高是手术治疗的难点。随着医疗技术水平的进步,多模态3D-Slicer血肿重建及神经内镜等技术的出现推动了外科微创技术体系的不断发展,而患者术后辅以早期康复可能会更有效地降低致残率。因此,外科微创技术治疗脑出血的适应证、关键技术、康复技术和卫生经济学评价亟需临床试验进行明确。目的探讨多模态3D-Slicer颅内血肿重建技术辅助神经内镜微创手术联合早期康复治疗HICH患者的临床效果。方法回顾性选取2018年1月—2020年1月唐山市人民医院神经外科收治的HICH伴偏瘫患者135例,根据治疗方法不同将采用多模态3D-Slicer软件技术辅助神经内镜微创手术治疗者分为A组(45例),显微镜下血肿清除术治疗者为B组(45例),穿刺引流术治疗者为C组(45例),患者均于术后进行早期康复治疗,术后电话随访6个月。比较三组患者住院时间、血肿清除率、术后偏瘫缓解率及术后再出血、颅内感染发生率,康复前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(ADL)评分,并比较三组患者术后6个月预后。结果A组患者住院时间短于B、C组,术后血肿清除率、术后偏瘫缓解率高于B、C组,术后再出血、颅内感染发生率低于B、C组(P<0.05);B组患者住院时间短于C组,术后血肿清除率、术后偏瘫缓解率高于C组,术后再出血、颅内感染发生率低于C组(P<0.05)。三组患者康复前NIHSS评分、ADL评分比较,差异无统计学意义(P>0.05)。A组患者康复后NIHSS评分低于B、C组,ADL评分高于B、C组(P<0.05);B组患者康复后NIHSS评分低于C组,ADL评分高于C组(P<0.05)。三组患者康复后NIHSS评分分别低于本组康复前,ADL评分分别高于本组康复前(P<0.05)。术后6个月,A组患者预后优于B、C组(P<0.001),B组患者预后优于C组(P<0.05)。结论多模态3D-SliceBackground Presently surgery is still the major technique used for the clinical treatment of hypertensive cerebral hemorrhage,but it suffers from the deficiency of high disability rate after the surgery.With the advancement of medical technology,new techniques like multimode 3D-Slicer hematoma reconstruction and neuroendoscopy were developed,and these facilitated the continuous improvement of the minimally invasive surgery.At the same time,early rehabilitation after surgery could effectively reduce the disability rate.Therefore,it is crucial to clarify the indications,to identify the key treatment and rehabilitation techniques,and to evaluate the health economy related to the minimally invasive surgery in the treatment of cerebral hemorrhage through clinical studies.Objective To investigate the effectiveness of the neural endoscopic minimally invasive surgery assisted with multimode 3D-Slicer intracranial hematoma reconstruction combined with early rehabilitation in treating patients with hypertensive cerebral hemorrhage accompanied with hemiplegia.Methods A retrospective study was conducted,in which 135 cases of patients diagnosed with hypertensive intracerebral hemorrhage accompanied with hemiplegia in the Department of Neurosurgery of Tangshan People's Hospital during January 2018 to January 2020 were identified for the study.The patients were divided into groups A,B,and C based on the different treatment methods adopted,with 45 cases in each group.Group A was treated with neural endoscopic minimally invasive surgery assisted with multimode 3D-Slicer intracranial hematoma reconstruction,group B was treated with microscopic hematoma removal surgery,and group C was treated with puncture drainage treatment.All patients received early rehabilitation treatment after the surgery,and then were followed up by telephone for 6 months.Performance indexes including the length of hospital stay,the hematoma clearance rate,the hemiplegia remission rate and the incidence of hemorrhage after surgery,the intracranial infection

关 键 词：颅内出血 高血压性 偏瘫 神经内镜微创手术 多模态 早期康复 

分 类 号：R743.34[医药卫生—神经病学与精神病学]