脑血管淀粉样变性相关脑出血的手术疗效分析  

Clinical efficacy of surgical treatment in cerebral amyloid angiopathy-associated intracerebral hemorrhage

作　　者：丁鹏 吴开福 曲春城[2] 续继军[1] DING Peng;WU Kai-fu;QU Chun-cheng;XU Ji-jun(Department of Neurosurgery,Tengzhou Central People's Hospital Affiliated to Jining Medical University,Tengzhou 277599,China;Department of Neurosurgery,The Second Hospital of Shandong University,Jinan 250033,China)

机构地区：[1]济宁医学院附属滕州市中心人民医院神经外科,山东滕州277599 [2]山东大学第二医院神经外科,济南250033

出　　处：《中国临床神经外科杂志》2022年第12期986-988,共3页Chinese Journal of Clinical Neurosurgery

基　　金：山东省医药卫生科技发展计划项目(2017WS853);济宁医学院教师科研扶持基金项目(JYFC2018FKJ060)。

摘　　要：目的探讨脑血管淀粉样变性相关脑出血(CAA-ICH)手术治疗的临床效果。方法回顾性分析2014年3月~2019年3月手术治疗的33例CAA-ICH的临床资料。结果33例中,年龄<70岁15例(低龄组),年龄≥70岁18例(高龄组)。小骨窗手术5例,标准骨瓣开颅手术28例(骨瓣回置20例,去骨瓣减压8例)。术后24 h复查头部CT显示血肿清除率在60~95%,平均(80.5±4.2)%。低龄组血肿清除率[(81.6±4.3)%]与高龄组[(79.4±5.1)%]无统计学差异(P>0.05)。低龄组术后发生再出血发生率(6.67%)、肺部感染发生率(40.00%)、下肢静脉血栓发生率(13.33%)与高龄组(分别为11.11%、55.56%、33.33%)无统计学差异(P>0.05)。术后随访1年,按GOS评分:死亡5例,植物生存5例,重残9例,中残10例,恢复良好4例。低龄组预后良好率(60.00%;GOS评分4~5分)明显高于高龄组(27.78%;P<0.05)。结论CAA-ICH术后并发症发生率高,总体预后不理想。相对年轻的CAA-ICH病人,显微手术是相对积极的治疗手段,可望获得较好的预后;但高龄CAA-ICH病人预后较差,全麻开颅手术应相对慎重。Objective To investigate the clinical efficacy of surgery for patients with cerebral amyloid angiopathy-associated intracerebral hemorrhage(CAA-ICH).Methods The clinical data of 33 patients with CAA-ICH who underwent surgical treatment from March 2014 to March 2019 were analyzed retrospectively.Results Of 33 patients,15 patients were younger than 70 years(younger group),and 18 patients were older than 70 years(older group).Five patients received small bone window craniotomy,and 28 standard craniotomy(bone flap replacement in 20 patients,and decompression in 8).Head CT 24 h after surgery showed that the hematoma clearance rate ranged from 60%to 95%,with an average of(80.5±4.2)%.There was no significant difference in the hematoma clearance rate between the younger group[(81.6±4.3)%]and the older group[(79.4±5.1)%;P>0.05].There was no significant difference in the incidence of postoperative rebleeding(6.67%),pulmonary infection(40.00%),and lower limb venous thrombosis(13.33%)between the younger group and the older group(11.11%,55.56%,33.33%,respectively;P>0.05).The one-year follow-up showed a GOS score of 1 in 5 patients,a score of 2 in 5,a score of 3 in 9,a score of 4 in 10,and a score of 5 in 4.The good prognosis rate in the younger age group(60.00%;GOS score of 4~5)was significantly higher than that(27.78%)of the older group(P<0.05).Conclusions The complication rate of CAA-ICH is high,and the overall prognosis is poor.For younger CAA-ICH patients,microsurgery is a relatively progressive treatment and is expected to obtain a good prognosis.However,the prognosis of elderly CAA-ICH patients is poor,and craniotomy under general anesthesia should be relatively cautious.

关 键 词：脑血管淀粉样变性相关脑出血 手术 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]