立体定向幕下入路脑干穿刺引流治疗脑干出血老年患者的临床研究  

Clinical study of stereotactic subtentorial approach for brainstem puncture and drainage in the treatment of brain stem hemorrhage in elderly patients

作　　者：郭士琨[1] 刘永生[1] Guo Shikun;Liu Yongsheng(Third Department of Neurosurgery,First People's Hospital of Shangqiu,Shangqiu,476100,China)

机构地区：[1]商丘市第一人民医院神外三科,商丘476100

出　　处：《中华老年医学杂志》2023年第5期557-562,共6页Chinese Journal of Geriatrics

基　　金：河南省医学科技攻关计划(LHGJ20191493)。

摘　　要：目的观察立体定向幕下入路脑干穿刺引流治疗脑干出血老年患者的疗效。方法回顾性分析商丘市第一人民医院神外三科2018年4月至2022年4月收治的脑干出血老年患者临床资料。按照严格的纳入及排除标准,筛选出行立体定向幕下入路脑干穿刺引流治疗且术后90 d内随访数据完整的65例脑干出血老年患者。查阅患者资料,记录患者手术时间、术后1 d血肿清除率、血肿腔引流管拔除情况及术后并发症;术后30 d、90 d的随访结果;采用30 d格拉斯哥结局量表(GOS)评估存活患者的短期临床结局;采用改良Rankin评分评估存活患者90 d的神经功能恢复情况。结果65例患者手术时间为1.1~2.8 h,平均(1.9±0.4)h。术后1 d复查头颅CT发现,患者血肿清除率为(84.6±13.6)%;血肿腔引流管在3~5 d内拔除,术后无1例出现侧脑室穿刺路径脑出血或引流管相关的颅内感染;术后随访30 d,9例患者病死,56例患者存活,存活率为86.2%。存活患者中5例暂时处于植物人状态,51例苏醒,但存在不同程度的残疾。存活患者术前血肿量少于病死患者,术前GCS评分低于病死患者(Z=2.386、2.009,P=0.017、0.045)。随访90 d,存活患者中,3例病死,53例存活,存活率为81.5%;存活患者中,22例患者神经功能恢复良好,临床治疗有效率为41.5%。结论立体定向幕下入路脑干穿刺引流术是一种较为有效、安全的治疗脑干出血老年患者的外科手术方法。Objective To observe the curative effect of stereotactic subtentorial approach for brainstem puncture and drainage on brain stem hemorrhage in elderly patients.Methods The clinical data of elderly patients with brain stem hemorrhage admitted to the Department of Neurosurgery,Shangqiu First People's Hospital from April 2018 to April 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria,a total of 65 elderly patients with brainstem hemorrhage who were treated with stereotactic subtentorial approach for brain stem puncture and drainage,and had complete follow-up data within 90 days after operation were selected.The patient's data were reviewed.The operation time,hematoma clearance rate on the first day after operation,the drainage tube extraction of hematoma cavity,and the postoperative complications were recorded.The follow-up results at 30 days and 90 days after the operation were also recorded.The 30-day Glasgow outcome scale(GOS)was used to evaluate the short-term clinical outcomes of surviving patients,while the modified Rankin score was used to evaluate the neurological function recovery of surviving patients at 90 days.Results The operation time of the 65 patients was 1.1-2.8 h,with an average of(1.9±0.4)h.On the first day after operation,CT scan showed that the hematoma clearance rate was(84.6±13.6)%.The drainage tube in hematoma cavity was removed within 3-5 days,and there was no puncture-related intracerebral hemorrhage or drainage tube-related intracranial infection after operation.During 30 days of follow-up,9 patients died and 56 patients survived,with a survival rate of 86.2%.Among the surviving patients,5 were temporarily in vegetative state and 51 were awake,with varoius degrees of disability.The preoperative hematoma volume of the surviving patients was significantly less than that of the dead patients,and the preoperative GCS score was significantly lower than that of the dead patients(Z=2.386,2.009,P=0.017,0.045).After 90 days of follow-up,3 patients died and 53 su

关 键 词：脑干出血 立体定位技术 穿刺抽液术 幕下入路 

分 类 号：R651.1[医药卫生—外科学]