3D-slicer辅助神经内镜术与显微手术治疗高血压脑出血的效果及预后的影响因素  

Effect of 3D-slicer-assisted neuroendoscopy and microsurgery in the treatment of hypertensive intracerebral hemorrhage and its prognostic factors

作　　者：鲍波[1] 李文化[1] 潘鹏 于效良 夏明[1] 谢震 BAO Bo;LI Wenhua;PAN Peng;YU Xiaoliang;XIA Ming;XIE Zhen(Xuzhou Tumor Hospital,Xuzhou 221005,China)

机构地区：[1]徐州市肿瘤医院,江苏徐州221005

出　　处：《中国实用神经疾病杂志》2022年第12期1543-1548,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探究3D-slicer辅助神经内镜术与显微手术治疗高血压脑出血的效果及预后的影响因素。方法前瞻性纳入2019-01—2021-12在徐州市肿瘤医院治疗的高血压脑出血患者102例为研究对象,分为A组51例与B组51例,A组采取显微镜下小骨窗开颅术治疗,B组采取3D-slicer辅助神经内镜术治疗。比较2组围术期指标、各项评分[NIHSS、日常生活活动能力(ADL)、格拉斯哥预后量表(GOS)]、并发症与预后,并分析预后相关影响因素。结果B组手术时间、术中出血量、血肿残留量与住院时间均低于A组(P<0.05),血肿清除率高于A组(P<0.05)。重复测量反差分析显示,2组GOS评分、ADL评分、NIHSS评分的时点、组间、交互比较差异有统计学意义(P<0.05)。2组术后GOS评分、ADL评分与术前相比均升高,NIHSS评分与术前相比均降低(P<0.05),且B组术后GOS评分、ADL评分高于A组,NIHSS评分低于A组(P<0.05)。B组患者总并发症发生率低于A组(5.88%对23.53%),且预后良好率高于A组(74.51%对43.14%)(P<0.05)。二元Logistic回归分析显示,高血压史≥10 a、出血量≥50 mL、出血破入脑室、肺部感染为影响预后的危险因素,术前GCS评分>5分为预后的保护因素(P<0.05)。结论3D-slicer辅助神经内镜手术治疗高血压脑出血可有效清除血肿,改善神经功能、日常生活能力与预后,而高血压史≥10 a、出血量≥50 mL、出血破入脑室、肺部感染为影响预后的危险因素,术前GCS评分>5分为预后的保护因素。Objective To explore the effect of 3D-slicer-assisted neuroendoscopy and microsurgery in the treatment of hypertensive intracerebral hemorrhage and its prognostic factors.Methods Totally 102 patients with hypertensive cerebral hemorrhage who were prospectively treated in Xuzhou Tumor Hospital from January 2019 to December 2021 were selected as the research objects.The 102 patients were divided into group A with 51 cases and group B with 51 cases.Group A was treated by microscopic craniotomy,and group B was treated by 3D-slicer-assisted neuroendoscopy.The perioperative indicators,scores(NIHSS,activities of daily living(ADL),Glasgow outcome scale(GOS)),complications and prognosis were compared between the two groups,and the prognostic factors were analyzed.Results The operation time,intraoperative blood loss,residual hematoma and hospital stay in group B were all lower than those in group A(P<0.05),and the hematoma clearance rate was higher than that in group A(P<0.05).Repeated-measures contrast analysis showed that there were significant differences in GOS score,ADL score and NIHSS score between the two groups(P<0.05).The GOS score and ADL score of the two groups were increased after surgery,while the NIHSS score was decreased before surgery(P<0.05).The GOS score and ADL score of the two groups were higher than those of the A group,and the NIHSS score of the two groups was lower than those of the A group(P<0.05).The total complication rate of group B was lower than that of group A(5.88%vs 23.53%),and the rate of good prognosis was higher than that of group A(74.51%vs43.14%)(P<0.05).Binary Logistic regression analysis showed that the history of hypertension more than 10years,the amount of bleeding more than 50 mL,the presence of rupture into the ventricle,and the presence of pulmonary infection were prognostic risk factors.Conclusion 3D-slicer assisted neuroendoscopy in the treatment of hypertensive intracerebral hemorrhage can effectively remove hematoma,improve neurological function,daily life function and progno

关 键 词：高血压脑出血 3D-slicer 神经内镜术 显微手术 小骨窗开颅术 预后 影响因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]