老年基底核区脑出血患者微创治疗策略选择对不同时期神经功能与预后影响  

Effect of MIT strategy on neurological function and outcome in elderly patients with basal ganglia intracerebral hemorrhage

作　　者：石立科 向定朝 何建青 胡旭 周劲旭 董吉荣 万琦 翟丽敬 王玉海 Shi Like;Xiang Dingchao;He Jianqing;Hu Xu;Zhou Jinxu;Dong Jirong;Wan Qi;Zhai Lijing;Wang Yuhai(Department of Neurosurgery,Chinese PLA Joint Service Support Forces No.904 Hospital,Taihu Hospital,Wuxi 214044,Jiangsu Province,China)

机构地区：[1]解放军联勤保障部队第九○四医院无锡市太湖医院神经外科,214044 [2]解放军联勤保障部队第九○四医院无锡市太湖医院神经内科,214044

出　　处：《中华老年心脑血管病杂志》2022年第2期167-170,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：江苏省无锡市科技局课题(CSZON1802)。

摘　　要：目的探讨不同微创治疗策略对老年基底核区脑出血患者术后不同时期的神经功能和预后影响差异,比较2种术式的临床应用价值。方法选择2016年12月~2020年11月无锡市太湖医院收治的老年基底核区脑出血患者292例,根据患者微创治疗方案分为A组144例[神经内镜(或显微镜)下皮质穿刺行血肿清除术]和B组148例(早期微创穿刺引流术)。回顾性分析比较2组临床资料,围术期指标;手术后超早期(1~3 d)、早期(4~7 d)和短期(8~14 d)残余血肿体积(RV)、血肿清除率(HCR);评估术后6个月预后情况。结果 B组手术时间、术中出血量显著低于A组,引流管留置时间明显长于A组(P<0.01)。A组术后超早期RV[(7.38±2.03)ml vs(14.35±2.18)ml]明显低于B组,HCR[(84.69±8.02)%vs(67.42±6.85)%]明显高于B组(P<0.01)。术后6个月A组预后良好率虽高于B组,但无统计学差异(93.06%vs 87.84%,P>0.05)。结论神经内镜(或显微镜)下皮质穿刺血肿清除术后超早期HCR更高,RV更低;早期微创穿刺引流术操作更为简便、操作难度更低,应用范围更广。Objective To study the effect of minimally invasive(MI) treatment strategies on neurological function and outcome in elderly patients with basal ganglia intracerebral hemorrhage(BGIH) after operation and to compare the clinical application values of MI puncture drainage procedure and neuroendoscopic cortical puncture.Methods Two hundred and ninety-two elderly patients with BGIH admitted to our hospital from December 2016 to November 2020 were divided into group A(n=144) and group B(n=148) according to the MI treatment strategy.The patients in group A underwent neuroendoscopic cortical puncture and those in group B underwent early MI puncture and drainage for hematoma removal.Their clinical data and perioperative parameters were compared by retrospective analysis.The residual hematoma volume(RV) and hematoma clearance rate(HCR) of two groups surgical procedures on days 1-3,on days 4-7 and on days 8-14 after operation, and the outcome of elderly patients with BGIH at month 6 after operation were assessed.Results The operation time was significantly shorter and the intraoperative blood loss was significantly less while the indwelling time of drainage tube was significantly longer in group B than in group A(P<0.01).The RV on days 1-3 was significantly lower while the HCR was significantly higher in group A than in group B(7.38±2.03 ml vs 14.35±2.18 ml, 84.69±8.02 % vs 67.42±6.85 %,P<0.01).The rate of good outcome was higher in group A than in group B at month 6 after operation, but no significant difference was detected in rate of good outcome between the two groups(93.06% vs 87.84%,P>0.05).Conclusion The ultra-early HCR is higher and the RV is smaller in elderly patients with BGIH after neuroendoscopic cortical puncture.The early MI puncture drainage procedure is simpler to operate with a wider application scope than neuroendoscopic cortical puncture.

关 键 词：脑血管基底神经节出血 最小侵入性外科手术 神经康复 预后 

分 类 号：R651.1[医药卫生—外科学]