立体定向与简易定位颅内置管治疗中等量高血压脑出血患者临床效果比较

目的：探讨立体定向仪引导颅骨钻孔置管吸引术和应用简易marker定位法引导颅骨钻孔置管吸引术治疗中等量高血压脑出血（HICH）2种术式的优缺点，为临床医师选择治疗中等量HICH的合理术式提供参考。方法：选取因HICH急诊入本院行颅骨钻孔置管吸引术患者43例，依照患者家属意愿，采用立体定向颅骨钻孔置管吸引术治疗20例（立体定向组），应用简易marker定位法引导颅骨钻孔置管吸引术治疗23例（简易定位组），均为中等出血量（30~70 mL）的基底节区HICH患者。观察并记录患者术后第1和3天血肿清除率、术后引流管留置时间、引流管在血肿腔内的长度、术后置管精确度、术后并发症和术后6个月格拉斯哥预后评分（GOS评分）。结果：与简易定位组比较，立体定向组患者术后置管精确度、术后第1天血肿清除率和术后6个月GOS评分明显升高（P<0.05），术后第3天血肿清除率、术后引流管留置时间、并发症发生率和再出血率比较差异均无统计学意义（P>0.05）。结论：对于中等量HICH患者，立体定向引导颅骨钻孔置管吸引术临床效果确切。及早清除颅内血肿可能更有利于改善患者HICH远期预后，值得临床上推广应用。

Comparison of clinical effects between hematoma aspiration surgery guided by stereotactic and simple positioning in treatment of patients with medium dose of hypertensive hemorrhage

Objective: To discuss the advantages and disadvantages of the two methods, which were hematoma aspiration surgery guided by stereotactic and simple marker positioning in the treatment of medium dose of hypertensive intracerebral hemorrhage(HICH),and to provide a reference for clinicians to choose the reasonable operation met hod.Methods: A total of 43 cases of HICH underwent hematoma aspiration surgery were selected.According to the patient's family willing,20 cases were underwent hematoma aspiration surgery guided by stereotactic (stereotactic group)and 23 cases were underwent simple marker positioning(simple positioning group).All the patients had medium dose of hypertensive hemorrhage(30-70 mL) in the basal ganglia region.The hematoma clearence rates of the patients at the 1st and 3rd days after operation,the postoperative drainage tube indwelling time,the lengths of drainage tube in hematoma,the postoperative cather accuracy,the postoperative complications, and the GOS scores 6 months after operation were observed and recorded.Results: Compared with simple positioning group,the postoperative catheter accuracy,the postoperative hematoma clearence rate on the 1st day,and the GOS score 6 months after operation of the patients in stereotactic group were increased(P<0.05); but the postoperative hematoma clearance rate on the 3rd day,the postoperative drainage tube indwelling time,the incidence of complification,and rebleeding rate had no significant differences(P>0.05).Conclusion: For the patients with medium dose of HICH, the clinical effect of stereotactic aspiration to guide the skull drilling insertion is precise.At the same time,removal of intracranial hematoma as early as possible is better for the HICH patients' prognosis,and it's worthy of clinical popularization and application.