极重型基底节出血手术疗效的影响因素分析

目的 探讨影响极重型基底节出血外科手术治疗疗效的相关因素.方法 对100例极重型基底节出血患者根据金谷分类法、CT分型、手术方式、基底节出血距脑疝症状出现时间、脑疝出现时间与进行手术的间隔时间进行分类,统计患者病死率及日常生活活动能力(ADL)评分,并进行统计学分析.结果 100例患者中,金谷分类法Ⅳb级患者70例中死亡40例,病死率为57.1％,Ⅴ级患者30例中死亡22例,病死率为73.0％,其间差异有统计学意义(P＜0.05).CT分型Ⅰ～Ⅱ型患者病死率为48.4％( 30/62),低于Ⅲ～Ⅴ型患者的病死率[84.2％( 32/38)],差异有统计学意义(P＜0.05).常规开颅手术治疗患者病死率为54.4％( 37/68),微创手术治疗患者病死率为78.1％ (25/32),其间差异有统计学意义(P＜0.05).术后生存患者ADL分级:开颅手术组Ⅰ级6例,Ⅱ级6例,Ⅲ级9例,Ⅳ级10例,Ⅴ级37例;微创手术组Ⅰ级0例,Ⅱ级0例,Ⅲ级1例,Ⅳ级6例,Ⅴ级25例,2组间差异有统计学意义(P＜0.05).16例患者于基底节出血2h内(其中7例≤1h)出现脑疝症状,手术治疗后仅2例生存,病死率为87.5％;而基底节出血12 h后出现脑疝症状的患者26例,治疗后存活16例,病死率为61.5％,其间差异有统计学意义(P＜0.05).脑疝出现时间与进行手术时间间隔≤1h的40例患者中18例死亡,病死率为45.0％;而时间间隔＞4h的12例患者术后全部死亡,病死率100.0％,其间差异有统计学意义(P＜0.05).结论 影响极重型基底节脑出血患者手术治疗疗效的因素有金谷分类法分级、CT分型、手术方式、基底节出血距脑疝症状出现时间、脑疝出现时间与进行手术的间隔时间等.

Analysis of the influencing factors of the surgical curative effect on severe basal ganglia hemorrhage

Objective To explore the neurosurgical curative effect on the severe basal ganglia hemorrhage. Methods One hundred patients were enrolled based on the Kanaya classification, the standard level of hypertensive severe basal ganglion and thalamus hemorrhage in CT image, surgical method and the time interval between cerebral hernia appearance and operation. Mortality and activity of daily living scale（ADL） scores were collected after operation. Results Forty patients of kanaya classification Ⅳb（40/70） and 22 cases of kanaya classification V died after treatment ; the difference of two groups mortality were statistically significant [ 57. 1% （40/70） vs 73.0% （22/30）, P 〈 0. 05 ]. The mortality rate of the grade Ⅰ-Ⅱin CT classification group was 48.4% （ 30/62 ） and that of Ⅲ～Ⅳ grade was 84. 2% （32/38） （P 〈0.05）. The mortality rate of conventional operation group was 54.4% and that of minimally invasive operation group was 78. 1% （P 〈 0. 05 ）. There were 6 patients of the grade Ⅰ , 6 patients of the grade Ⅱ , 9 patients of the grade Ⅲ, 10 patients of the grade Ⅳ and 37 patients of the grade V in ADL classification in conventional operation group. However, there were 0 patient of the grade Ⅰ , 0 patients of the grade Ⅱ , 1 patients of the grade Ⅲ,6 patients of the grade Ⅳ and 25 patients of the grade V in minimally invasive operation group （ P 〈 0. 05 ）. Sixteen patients in this group （ ≤ 1 h ： 7 patients ; 1-2 h ： 9 patients ） had symptoms of cerebral hernia within 2 hours after basal ganglia hemorrhage and only 2 survived after operation. Twenty-six patients had symptoms of cerebral hernia 12 hours after basal ganglia hemorrhage and 16 of them（61.54% ） survived. Forty patients received surgical treatment within 1 hours after symptoms of cerebral hernia appeared but 18 of them（45.0% ） died. All patients who received operation later than 4 hours after cerebral hernia died. Conclusion The influential factors of surgical treatment of severe basal ganglia hemorrhage include grade of Kanaya classification, CT classification, surgical procedure, period of cerebral hernia appearance and intervention time of operation.