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中华卫生应急电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 74 -78. doi: 10.3877/cma.j.issn.2095-9133.2020.02.003

所属专题： 文献；

论著

手术治疗高血压基底节脑出血立体定向钻空引流的疗效分析
苏道庆1, 马红玲2, 杜芳3, 张士刚1, 周光华1, 刘怀新1, 惠浴祚1, 李国梁1, 任松涛1,†()   
  1. 1. 252000　山东聊城，山东第一医科大学附属聊城医院、聊城人民医院脑科医院神经外科
    2. 252000　山东聊城，山东第一医科大学神经内科
    3. 252000　山东聊城，山东第一医科大学信息科
  • 收稿日期:2020-01-05 出版日期:2020-04-18
  • 通信作者: 任松涛

Stereotactic drilling surgery for treatment of hypertensive cerebral hemorrhage in basal ganglia

Daoqing Su1, Hongling Ma2, Fang Du3, Shigang Zhang1, Guanghua Zhou1, Huaixin Liu1, Yuzuo Hui1, Guoliang Li1, Songtao Ren1,†()   

  1. 1. Department of Neurosurgery, Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000, China
    2. Neurology Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000, China
    3. Information Centre, Liaocheng People’s Hospital and Liaocheng Brain Hospital, Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000, China
  • Received:2020-01-05 Published:2020-04-18
  • Corresponding author: Songtao Ren
  • About author:
    Corresponding author: Ren Songtao, Email:
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引用本文：

苏道庆, 马红玲, 杜芳, 张士刚, 周光华, 刘怀新, 惠浴祚, 李国梁, 任松涛. 手术治疗高血压基底节脑出血立体定向钻空引流的疗效分析[J/OL]. 中华卫生应急电子杂志, 2020, 06(02): 74-78.

Daoqing Su, Hongling Ma, Fang Du, Shigang Zhang, Guanghua Zhou, Huaixin Liu, Yuzuo Hui, Guoliang Li, Songtao Ren. Stereotactic drilling surgery for treatment of hypertensive cerebral hemorrhage in basal ganglia[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2020, 06(02): 74-78.

目的

比较非手术治疗与立体定向手术治疗中小量高血压基底节脑出血的临床疗效。

方法

回顾性分析聊城市人民医院脑科医院神经内、外科2016年7月至2019年7月收治的182例高血压基底节性脑出血(20～40 mL)患者临床资料，其中男性102例，女性80例；年龄38～79岁，平均(52.9±1.9)岁。按照患者所接受的治疗方案将研究对象进行分组：90例采用了规范药物治疗者为非手术治疗组，92例接受了立体定向钻孔引流手术者为定向引流组。分别根据动态电子计算机断层扫描(CT)评价其排空率，在院期间再出血率和颅内感染率评价其临床安全性，平均住院日及费用评价其社会经济负担；全部随访6个月，根据病死率、改良Rankin量表评分(modified Rankin scale, mRs)评价其远期预后。

结果

与非手术治疗组比较，定向引流组在发病后第7天的血肿排空率更高[(90.67±3.31)%比(25.23±2.41)%]、平均住院日缩短[(10.1±2.8)d比(20.3±3.9)d]、平均住院费降低[(18 158.1±2 171.3)元比(21 493.3±3 729.5)元]，差异均有统计学意义(P<0.05)，但两组的在院期间再出血率(6.7%比5.4%)和颅内感染率[1.1%(1/90)比3.3%(3/92)]的差异均无统计学意义(P>0.05)。治疗6月后，定向引流组的mRs[(2.57±0.56)分比(3.42±0.21)分]和病死率[10.0%(9/90)、2.2%(2/92)]均低于非手术治疗组，差异均有统计学意义(P<0.05)。

结论

针对中小量高血压基底节性脑出血，与非手术治疗比较，立体定向手术在具备安全性的同时，临床预后更好、经济负担更低。

关键词: 高血压基底节脑出血, 立体定向手术, 非手术治疗, 安全性, 预后
Objective

To compare the clinical safety, prognosis and economic burden of conservative and stereotactic surgery in the treatment of hypertensive cerebral hemorrhage in basal ganglia (HICH) (20-40 mL).

Methods

The clinical data of 182 patients with HICH (20-40 mL) admitted to Liaocheng Brain Hospital from July 2016 to July 2019 were retrospectively analyzed. There were 102 males and 80 females, aged 38 to 79 years, with an average age of (52.9±1.9) years. The study subjects were divided into two groups according to the treatment received by patients: 90 patients who received standard drug treatment were conservative treatment groups, and 92 patients who received stereotactic drilling surgery were directional drainage groups. Dynamic CT was used to evaluate the evacuation rate of the hematoma, complication rate to the clinical safety, and mean hospital stay and cost to socioeconomic burden All patients were followed up for 6 months, and the prognosis was evaluated according to mortality and modified Rankin scale (mRs).

Results

Compared with the conservative treatment group, the evacuation rate of hematoma on the 7th day after onset was higher in the targeted drainage group [(90.67±3.31)% vs. (25.23±2.41)%], and the average hospital stay was shortened [(10.1±2.8) d vs. (20.3±3.9) d], the average hospitalization cost was reduced [(18 158.1±2 171.3) yuan vs. (21 493.3±3 729.5) yuan], and the differences were statistically significant (P <0.05). There was no statistically significant difference in re-bleeding rate (6.7% vs. 5.4%) and intracranial infection rate [1.1% (1/90) vs. 3.3% (3/92)] during the hospital (P> 0.05). After 6 months of treatment, the mRs [(2.57±0.56) vs. (3.42±0.21)] and mortality [10.0% (9/90) vs.2.2% (2/92)] in the directional drainage group were lower than those of conservative treatment group, and the difference was statistically significant (P<0.05).

Conclusion

For patients with HICH (20-40 mL), stereotactic surgery is safer, the clinical prognosis is better and the economic burden is lower, compared with conservative treatment.

Key words: Hypertensive cerebral hemorrhage in basal ganglia, Stereotactic surgery, Conservative treatment, Safety, Prognosis
表1 两组中小出血量基底节区HICH患者的基线资料比较
组别 例数 年龄(岁，±s) 性别[例(%)] 嗜烟酒[例(%)] 血肿位置[例(%)] 血肿体积(mL，±s) GCS评分(分，±s)
男 女 有 无 左 右
非手术治疗组 90 52.4±3.6 49(54.4) 41(45.6) 43(47.8) 47(52.2) 44(48.9) 46(51.1) 24.9±3.9 12.5±1.9
定向引流组 92 53.3±5.7 52(56.5) 40(43.5) 45(48.9) 47(51.1) 45(48.9) 47(51.1) 25.2±4.7 12.3±1.6
t/χ2值 ? －0.22 0.08 ? 0.02 ? 0.00 ? －0.11 0.23
P值 ? >0.05 >0.05 ? >0.05 ? >0.05 ? >0.05 >0.05
表2 两组中小出血量基底节区HICH患者治疗后的临床评价指标比较(±s)
组别 例数 血肿排空率(%) 再出血率[例(%)] 颅内感染率[例(%)] 平均住院日(d) 平均住院费用(d) 6个月死亡率[例(%)] mRs (分)
非手术治疗组 90 25.23±2.41 6(6.7%) 1(1.1%) 20.3±3.9 21493.3±3729.5 9(10.0%) 3.42±0.21
定向引流组 92 90.67±3.31 5(5.4%) 3(3.3) 10.1±2.8 18158.1±2171.3 2(2.2%) 2.57±0.56
t/χ2值 ? －147.52 0.12 ? 10.32 6.83 4.91 7.89
P值 ? <0.05 >0.05 >0.05 <0.05 <0.05 <0.05 <0.05
图1 保守治疗组中小出血量基底节区HICH患者的头颅CT
图2 定向引流组中小出血量基底节区HICH患者的头颅CT
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