CT引导钻孔穿刺抽吸引流术治疗老年小脑出血患者的临床研究  

Clinical study of CT-guided drilling,aspiration and drainage for cerebellar hemorrhage in senile patients

作　　者：吴恒浩 申娟茹[2] 王景波 张圣旭 宋振 曹廷亮 杨文涛 张万宏 Wu Henghao;Shen Juanru;Wang Jingbo;Zhang Shengxu;Song Zhen;Cao Tingliang;Yang Wentao;Zhang Wanhong(Department of Neurosurgery,Kaifeng Central Hospital,Kaifeng 475000,Henan Province,China)

机构地区：[1]开封市中心医院神经外科,475000 [2]开封大学医学部

出　　处：《中华老年心脑血管病杂志》2024年第6期661-664,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200841)。

摘　　要：目的探讨CT引导钻孔血肿穿刺抽吸引流术治疗75岁以上小脑出血患者的疗效。方法回顾性分析2016年1月至2022年12月开封市中心医院收治的75岁以上小脑出血患者89例,根据患者意愿采用不同手术方式并分为穿刺组42例(采用CT引导钻孔血肿穿刺抽吸引流治疗)和开颅组47例(采用开颅手术治疗)。比较2组患者格拉斯哥昏迷评分(GCS)、术前出血量、ICU住院时间、术后并发症、病死率及术后3个月存活患者改良的Rankin量表(mRS)评分。结果2组患者年龄、男性、GCS、术前出血量、术后24 h再出血发生率、术后3个月病死率比较,差异无统计学意义(P>0.05)。穿刺组ICU住院时间、术后颅内感染发生率低于开颅组[(7.10±1.43)d vs(8.87±1.39)d,P=0.000;4.76%vs 19.15%,P=0.040]。术后随访3个月,穿刺组存活患者(39例)mRS评分良好率高于开颅组存活患者(42例),mRS评分低于开颅组存活患者(P<0.05)。结论CT引导钻孔穿刺抽吸引流术治疗75岁以上小脑出血患者能降低手术感染率,改善预后,是有效的治疗方法。Objective To investigate the clinical efficacy of CT-guided drilling,hematoma aspiration and drainage for senile cerebellar hemorrhage.Methods A retrospective analysis was performed on 89 very old patients(75-89 years old)with cerebellar hemorrhage admitted to our hospital from January 2016 to December 2022.According to their wishes,different surgical treatments were adopted,and thus they were divided into puncture group(42 cases,CT-guided drilling,aspiration and drainage for hematoma)and craniotomy group(47 cases,craniotomy).GCS,preoperative hematoma volume,length of ICU stay,postoperative complications,mortality rate and the mRS score in 3 months postoperatively in the survival were compared between the 2 groups.Results There were no significant differences in age,male ratio,GCS score,preoperative hematoma volume,recurrence rate at 24 h postoperatively and mortality rate at 3 months postoperatively between 2 groups(P>0.05).The puncture group had significantly shorter length of ICU stay(7.10±1.43 d vs 8.87±1.39 d,P=0.000)and lower intracranial infection rate(4.76%vs 19.15%,P=0.040)than the craniotomy group.In 3 months of follow-up after surgery,the rate of good mRS score was higher in the puncture group than the craniotomy group,and the mRS score was lower in the former group than the latter one(P<0.05).Conclusion CT-guided drilling,aspiration and drainage for hematoma can reduce the infection rate and improve the prognosis,and is an effective approach in the treatment of patients over 75 years old with cerebellar hemorrhage.

关 键 词：脑出血 创伤性 预后 CT引导钻孔穿刺抽吸引流术 

分 类 号：R651.12[医药卫生—外科学]