立体定向额叶与枕顶叶入路治疗高血压脑出血疗效及术后再出血研究  

Analysis of efficacy and postoperative rebleeding after stereotactic frontal and occipitoparietal approaches for hypertensive intracerebral hemorrhage

作　　者：李想 汪兰 严欣江[1] 毛丹丹 刘炜 徐勇明 周日成 方敏[2] Li Xiang;Wang Lan;Yan Xinjiang;Mao Dandan;Liu Wei;Xu Yongming;Zhou Richeng;Fang Min(Department of Neurosurgery,Quzhou People's Hospital,Quzhou,Zhejiang 324000,China;Department of Radiology,Zhejiang Quhua Hospital,Quzhou,Zhejiang 324000,China)

机构地区：[1]衢州市人民医院神经外科,浙江衢州324000 [2]浙江衢化医院放射科,浙江衢州324000

出　　处：《中国微侵袭神经外科杂志》2024年第8期453-457,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：衢州市指导性科技攻关项目(编号:2022034)。

摘　　要：目的比较立体定向下额叶入路与枕顶叶入路治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)的疗效,并分析术后再出血危险因素。方法选取190例接受血肿清除术治疗的HICH患者作为研究对象,按不同手术入路分为对照组(92例)与研究组(98例)。对照组患者应用立体定向辅助下枕顶叶入路治疗,研究组患者应用立体定向辅助下额叶入路治疗。对比两组临床相关指标、术后并发症、日常生活能力量表(activity of daily living scale,ADL)分级情况。应用多因素Logistics回归分析,探究HICH术后再出血的危险因素。结果两组性别、年龄、发病部位比较,差异无统计学意义(P>0.05)。与对照组比较,研究组患者术后血肿排空率较高,术中出血量较少,手术时间、住院时间、ICU入住时间较短,术后并发症发生率较低,术后ADL分级Ⅰ级、Ⅱ级占比较高,Ⅲ级、Ⅳ级占比较低(P<0.05)。单因素分析显示:HICH患者术后再出血与性别、年龄、并发基础病、使用镇痛镇静药物无关(P>0.05)。单因素分析与多因素Logistics回归分析显示:收缩压>160mmHg、舒张压>90mmHg、术前血肿量≥30ml、术前格拉斯哥昏迷评分(Glasgow coma scale,GCS)<10分、手术方式为枕顶叶入路是HICH患者术后再出血的危险因素(均P<0.05)。结论HICH患者采用立体定向辅助下额叶入路行血肿清除术后,临床相关症状改善较明显,且并发症发生率较低。收缩压、舒张压、术前血肿量、术前GCS评分、手术方式均为影响HICH患者术后再出血的因素。Objective To investigate the efficacy and postoperative rebleeding of stereotactic-assisted frontal and occipitoparietal approaches in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods A total of 190 patients with HICH who underwent hematoma evacuation were recruited and divided into a control group(92 cases)and a study group(98 cases)based on different surgical approaches.The control group underwent stereotactic-assisted occipitoparietal approach surgery,while the study group underwent stereotactic-assisted frontal approach procedure.Clinical indicators,postoperative complications,and Activities of Daily Living(ADL)scores were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for HICH.Results No significant differences were observed between the two groups in terms of gender,age,and location of hemorrhage(P>0.05).Compared with the control group,the study group had a higher hematoma evacuation rate,less intraoperative blood loss,shorter operative time,hospitalization duration,and ICU stay,as well as a lower incidence of postoperative complications(P<0.05).The study group also had a higher proportion of patients with ADL grades Ⅰ and Ⅱ and a lower proportion of patients with grades Ⅲ and Ⅳ after surgery(P<0.05).Univariate analysis revealed that postoperative rebleeding in HICH patients was not associated with gender,age,underlying comorbidities,or the use of analgesic and sedative medications(P>0.05).Univariate analysis and multivariate logistic regression analysis revealed that systolic blood pressure>160 mmHg,diastolic blood pressure>90 mmHg,preoperative hematoma volume>30 ml,preoperative GCS score<10,and occipitoparietal approach were the risk factors for postoperative rebleeding in HICH patients(all P<0.05).Conclusions Stereotactic-assisted frontal approach for hematoma evacuation in HICH patients would result in more significant improvement in clinical symptoms and a lower incidence of complications.Systolic blood pressur

关 键 词：颅内出血 高血压性 立体定位技术 额叶入路 枕顶叶入路 

分 类 号：R743[医药卫生—神经病学与精神病学]