中等量高血压基底节脑出血手术适应证的探讨  

Discussion on Surgical Indications of Medium-volume Hypertensive Basal Ganglia Hemorrhage

作　　者：王浩宇 崔建忠[1] 魏建强[1] 夏景瑞 孟禄恩 洪铭岩[1] 王宏宇[1] 刘宽 栾小红 王凯杰[1] Wang Haoyu;Cui Jianzhong;Wei Jianqiang(Department of Neurosurgery,Tangshan Gongren Hospital,Tangshan 063000,China)

机构地区：[1]唐山市工人医院神经外科,唐山063000 [2]唐山市工人医院科教部,唐山063000

出　　处：《中国微创外科杂志》2023年第2期87-92,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：2020年度河北省医学适用技术跟踪项目计划(GZ2020077)。

摘　　要：目的 探讨中等量高血压基底节脑出血患者能否从微创手术中获益。方法 回顾性比较我院2018年8月~2021年8月222例中等量高血压基底节脑出血采用颅脑手术头架微创治疗(微创手术组112例)或保守治疗(保守治疗组110例)的疗效,观察指标包括治疗后7 d再出血率,30 d病死率,3、7 d血肿残留量,90、180 d mRS评分,180 d患侧上、下肢肌力。结果 2组术后7 d再出血率与30 d病死率差异无统计学意义[2.7%(3/112)vs.0.9%(1/110),χ^(2)=0.237,P=0.627;2.7%(3/112)vs.4.6%(5/110),log-rank χ^(2)=0.547,P=0.460];微创手术组术后3、7 d血肿残留量中位数明显少于保守治疗组[5.6(4.0,8.0)ml vs. 21.6(19.6,24.3)ml,Z=-12.812,P=0.000;1.8(0.0,3.1)ml vs. 18.6(15.8,21.4)ml,Z=-12.901,P=0.000];微创手术组术后180 d患侧上、下肢肌力明显好于保守治疗组(Z=-2.566,P=0.010;Z=-2.039,P=0.041);微创手术组术后90、180 d mRS评分显著优于保守治疗组(Z=-2.412,P=0.016;Z=-5.559,P=0.000)。结论 对于20~40 ml中等量高血压基底节脑出血患者,微创手术安全性好,早期血肿清除率高,可以改善180 d患侧肌力及神经功能预后。Objective To explore whether patients with medium-volume hypertensive basal ganglia hemorrhage can benefit from minimally invasive surgery. Methods From August 2018 to August 2021, 222 patients with medium-volume hypertensive basal ganglia hemorrhage were treated. The efficacy was retrospectively compared between minimally invasive treatment using craniocerebral surgery frame(MIS group, 112 cases) and conservative treatment(conservative treatment group, 110 cases). The observation indexes included re-bleeding rate in 7 d, mortality rate in 30 d, hematoma residual amount at 3 d and 7 d, Modified Rankin Scale(mRS) at 90 and 180 d, and muscle strength of the affected upper and lower limbs at 180 d. Results There were no differences in 7 d re-bleeding rate and 30 d mortality rate between the MIS group and conservative treatment group [2.7%(3/112) vs. 0.9%(1/110), χ^(2)=0.237, P=0.627;2.7%(3/112) vs. 4.6%(5/110), log-rank χ^(2)=0.547, P=0.460]. The hematoma residual amount at 3 d and 7 d in the MIS group was smaller than that in the conservative treatment group [5.6(4.0, 8.0) ml vs. 21.6(19.6, 24.3) ml, Z=-12.812, P=0.000;1.8(0.0, 3.1) ml vs. 18.6(15.8, 21.4) ml, Z=-12.901, P=0.000]. At 180 d, the muscle strength of upper and lower limb of affected side in the MIS group was superior to those in the conservative treatment group [Z=-2.566, P=0.010;Z=-2.039, P=0.041]. At 90 d and 180 d, the mRS scores in the MIS group were better than those in the conservative treatment group(Z=-2.412, P=0.016;Z=-5.559, P=0.000). Conclusion For 20-40 ml of medium-volume hypertensive basal ganglia hemorrhage, minimally invasive surgery has safety and high clearance rate of early hematoma, and can improve the muscle strength and neurological function prognosis of the affected side at 180 d.

关 键 词：微创手术 高血压基底节脑出血 肌力分级 神经功能 

分 类 号：R651.1[医药卫生—外科学]