应用CT血管成像点征选择老年中等量脑出血超早期手术方式的临床研究

目的探讨应用CT血管成像(CTA)点征选择老年基底节中等量脑出血超早期钻孔引流,或开颅手术治疗的手术方式。方法选择2015年4月~2019年1月入住我院适合手术的老年中等量基底节脑出血(出血量30~60 ml)且家属同意超早期手术治疗患者216例,根据入院后患者是否同意行头颅CTA检查分为应用组(同意行CTA者)112例,对照组(不同意行CTA者)104例,应用组CTA点征阳性者,进入开颅亚组45例,CTA点征阴性者进入引流亚组67例。对照组根据患者家属选择的手术方式,分为开颅亚组46例,引流亚组58例。2组引流手术亚组超早期均给予微创血肿软通道引流术,并给予血肿内纤溶药物治疗。2组开颅亚组患者均给予超早期开颅血肿清除术治疗。对比应用组与对照组引流亚组及开颅亚组患者治疗效果的差异,评估应用CTA点征选择老年基底节中等量脑出血超早期手术方式的价值。结果与对照组比较,应用组总有效率显著增高,差异有统计学意义(72.3%vs 53.8%,P<0.05)。术后应用组血肿增大、死亡、颅内感染显著低于对照组(2.7%vs 13.5%,3.6%vs15.4%,1.8%vs 7.7%,P<0.05);术后对照组肺部感染与应用组比较差异无统计学意义(25.0%vs 17.9%,P>0.05)。结论通过CTA点征选择引流或开颅手术,可明显改善患者预后,CTA点征可作为客观指标是选择中等量基底节脑出血超早期手术方式。

Application of spot signs on CTA in selecting ultraearly surgical procedure for elderly patients with moderate cerebral hemorrhage

Objective To study the application of spot signs on CTA in selecting ul、raearly surgical procedure(trepanning drainage or craniotomy)for elderly patients with moderate basal ganglia hemorrhage.Methods Two hundred and sixteen elderly patients with moderate basal ganglia hemorrhage(30 ml-60 ml)admitted to our hospital for ultraearly surgery were divided into CTA group(n=112)and control group(n=104).The patients in CTA group were further divided into craniotomy subgroup(n=45)and drainage subgroup(n=67)according to the positive spot signs on CTA while those in control group were further divided into craniotomy subgroup(n=45)and drainage subgroup(n=57)according to the surgical procedure selected by their family menbers.The patients in CTA group and control group underwent ultraearly minimally invasive soft channel drainage of hematoma and internal fibrinolytic therapy for hematoma.The patients in both craniotomy subgroups underwent ultraearly craniotomy to remove their hematoma.The curative effects in CTA group and control group were compared and the value of spot signs on CTA in selecting ultraearly surgical procedure for elderly patients with moderate basal ganglia hemorrhage was assessed.Results The total effective rate of drainage or craniotomy was significantly higher in CT A group than in control group(72.3%vs 53.8%,P<0.05).The size of hematoma was significantly larger while the rate of deaths and intracranial infection was significantly lower in CTA group than in control group after operation(2.7%vs 13.5%,3.6%vs 15.4%,1.8%vs 7.7%,P<0.05).No significant difference was detected in pulmonary infection between control group and CTA group(25.0%vs 17.9%,P>0.05).Conclusion Drainage or craniotomy selected according to the spot signs on CTA can effectively improve the outcome of elderly patients with moderate basal ganglia hemorrhage.Spot signs on CTA can be used as an objective index in selecting ultraearly surgical procedure for elderly patients with moderate basal ganglia hemorrhage.