立体定向手术与内科治疗中小量基底核区高血压性脑出血的对比研究

目的研究中小量（15～40m1）基底核区高血压性脑出血应用立体定向治疗与内科保守治疗对患者病死率、运动功能及预后的影响。方法2003年1月～2013年1月，我院收治中小量基底核区高血压性脑出血164例，其中82例行立体定向手术抽吸结合尿激酶引流治疗，另82例行内科保守治疗。比较2组血肿清除时间、30d病死率、患侧肢体运动功能和90d格拉斯哥预后评分（Glasgow outcome score，GOS）。结果立体定向治疗组血肿消散时间（3.8±1.1）d，明显短于内科治疗组的（19.9±3.5）d（t=-39.463，P=0.000）。2组30d病死率差异无显著性。立体定向组治疗30d病肢肌力4～5级[43.9％（36／82）vs.28.0％（23／82）,X^2=4.474，P=0.034]和90 d GOS 5分者的比例明显高于内科治疗组[53.7％（44／82）vs.36.6％（30／82），X^2=4.826，P=0.028]。结论对于中小量高血压性脑出血，行立体定向手术治疗比内科治疗能明显加快血肿清除时间，改善患者的功能预后。

A Comparative Study of Stereotactic Surgery and Conservative Treatment for Small- and Moderate-volume Hypertensive Cerebral Hemorrhage in Basal Ganglia Area

Objective To evaluate the mortality rate, motor function and prognosis of small- and moderate-volume hypertensive cerebral hemorrhage in basal ganglia area treated by stereotactic surgery or conservative treatment. Methods From January 2003 to January 2013, 164 cases of small- and moderate-volume hypertensive cerebral hemorrhage in basal ganglia area were treated in our hospital. Of the 164 patients, 82 were treated with stereotactie surgery combined with instillation of urokinase, and 82 received conservative treatment. The hematoma clearance time, the mortality rate and motor function of the paralytic limbs at day 30 and the Glasgow outcome score （GOS） at day 90 after the treatment were compared between the two groups. Results In stereotactic group, the dissipation time of hematoma （3.8±1.1 d） was significantly shorter than that in conservative group （ 19.9 ± 3.5d, t = -39.463, P =0.000）. The mortality rate at day 30 after the treatment was not significantly different between the two groups. In stereotactic group, the rate of patients＇ diseased limb with muscle strength level 4 - 5 at day 30 and GOS scores of 5 points at day 90 after the treatment were significantly higher than those in conservative group [43.9% （36/82） vs. 28.0% （23/82） , X^2 =4. 474, P=0.034; 53.7% （44/82） vs. 36.6% （30/82）,X^2=4.826, P=0.028]. Conclusion For patients with intracerebral hematoma between 15 ml and 40 ml in volume, stereotactic surgery has shorter hematoma clearance time, less mortality rate and better prognosis of motor function.