立体定向抽吸手术治疗原发性脑干出血的疗效及其影响因素分析  

Analysis of therapeutic effect and influencing factors of stereotactic aspiration in the treatment of primary brain stem hemorrhage

作　　者：李岩 吴冬雪 刘建峰[1] 李辉[1] 王冀伟 李亚雄 郭昊 纪乐 陈凌友 李聪慧 Li Yan;Wu Dongxue;Liu Jianfeng;Li Hui;Wang Jiwei;Li Yaxiong;Guo Hao;Ji Le;Chen Lingyou;Li Conghui(Department of Neurosurgery,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Radiology,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院神经外科,石家庄050000 [2]河北医科大学第一医院放射科,石家庄050000

出　　处：《中华神经外科杂志》2021年第12期1257-1261,共5页Chinese Journal of Neurosurgery

基　　金：河北省卫健委医学科学研究指令性课题(20200120)。

摘　　要：目的探讨立体定向抽吸手术治疗原发性脑干出血的疗效及其影响因素。方法回顾性分析2019年2月至2020年2月河北医科大学第一医院神经外科收治的65例原发性脑干出血患者的临床资料。所有患者均采用立体定向抽吸手术治疗,对合并梗阻性脑积水者术中同时行侧脑室枕角外穿刺引流术。随访术后30 d患者的生存状态,采用改良Rankin量表评分(mRS)评估90 d神经功能恢复情况。应用单因素分析和多因素logistic回归分析方法探讨患者的生存状态和神经功能恢复情况的影响因素。结果65例患者中,15例(23.1%)于术后30 d内死亡,术后90 d,21例(32.3%)患者神经功能恢复良好(mRS 0~3分)。多因素logistic回归分析结果表明,血肿分型为影响原发性脑干出血患者术后30 d生存状态(OR=0.255,95%CI:0.074~0.880,P=0.031)和神经功能恢复情况的独立影响因素(OR=0.029,95%CI:0.002~0.483,P=0.014)。结论采用立体定向抽吸手术治疗的巨大型血肿患者的死亡概率高于其他血肿分型患者。单侧被盖型血肿患者的神经功能恢复情况好于其他分型患者。立体定向抽吸手术是原发性脑干出血的有效治疗方法。Objective To explore the efficacy and influencing factors of stereotactic aspiration in the treatment of primary brain stem hemorrhage(PBH).Methods The clinical data of 65 patients with PBH admitted to the Department of Neurosurgery of the First Hospital of Hebei Medical University from February 2019 to February 2020 were retrospectively analyzed.All patients were treated with stereotactic aspiration,and the patients with obstructive hydrocephalus were treated with occipital ventricle puncture and drainage at the same time.The survival status(mortality)of the patients was followed up 30 days after the operation,and the modified Rankin scale(mRS)was used to evaluate the 90-day neurological function recovery.Univariate and multivariate logistic regression analyses methods were used to explore the influencing factors of patients′survival status and neurological function recovery.Results Of the 65 patients,15 patients(23.1%)died 30 days after the operation,and 21 patients(32.3%)reported good recovery of neurological function(mRS of 0 to 3 points).The results of multivariate logistic regression analysis showed that hematoma classification was an independent influencing factor of the survival of patients with PBH(OR=0.255,95%CI:0.074-0.880,P=0.031)and the recovery of neurological function(OR=0.029,95%CI:0.002-0.483,P=0.014).Conclusions The death probability of patients with giant hematoma who underwent stereotatic aspiration is higher than that of patients with other hematoma types.The neurological function recovery of patients with unilateral tegmental hematoma is better than that of patients with other types.Stereotactic aspiration surgery is an effective treatment for PBH and has clinical promotion value.

关 键 词：脑出血 脑干 治疗结果 因素分析 统计学 立体定向抽吸 

分 类 号：R651.12[医药卫生—外科学]