微创钻孔引流位置不同对基底节区高血压性脑出血患者血肿清除量、生活质量及并发症发生风险的影响

目的研究微创钻孔的不同引流位置对基底节区高血压性脑出血患者血肿清除量、生活质量及并发症发生风险的影响。方法选取2013~2016年于我院治疗的108例基底节区高血压性脑出血患者作为研究对象。根据治疗方法分为额部组(n=48)和颞部组(n=60例),所有患者术前均行常规血压监测并检查凝血项,并行颅脑CT检查。比较两组患者术后血肿残余量、血肿清除完成时间、意识障碍恢复时间、再出血发生情况并发症发生率及术后2个月的日常生活能力(ADL)评分。结果额部组患者术后3d血肿残余量、血肿清除完成时间分别为(23.2±4.8)ml、(12.2±1.5)d,颞部组分别为(26.7±5.8)ml、(13.8±1.8)d,差异有统计学意义(P0.05)。额部与颞部组在术后7d血肿残余量、意识障碍恢复时间、再出血发生状况、住院天数两方面差异不具有显著性(P0.05)。额部组并发症发生率为10.4%,颞部组为11.7%,差异无统计学意义(P0.05)。额部组与颞部组术后ADL评分分别为(55.1±17.3)分和(53.4±11.9)分,差异无统计学意义(P0.05)。结论基底节区高血压性脑出血患者的微创钻孔引流位置不同对于患者早期的血肿清除有差异,穿刺方向与基底节血肿之长轴相平行的额部组的血肿清除更为干净,在并发症发生率及患者生活质量方面并无影响。

Effects of different minimally invasive drilling and drainage positions on hematoma clearance, quality of life, and risk of complications in patients with hypertensive intracerebral hemorrhage in the basal ganglia

Objective To examine the effects of different minimally invasive drilling and drainage positions on hematoma clearance, quality of life, and the risk of complications in patients with hypertensive intracerebral hemorrhage in the basal ganglia.Methods One hundred and eight cases of hypertensive intracerebral hemorrhage in the basal ganglia treated in our hospital from 2013 to 2016 were retrospectively analyzed. The 108 cases were divided according to the treatment method into frontal group (n=48) and temporal group (n=60). All patients underwent routine blood pressure monitoring and coagulation tests, as well as CT examination of the brain, prior to surgery. Residual hematoma volume, hematoma clearance time, consciousness recovery time, postoperative rebleeding, incidence of complications, and the ability of daily living (ADL) score at 2 months after operation were compared between the two groups.Results Postoperative (3 d) residual hematoma volume and hematoma clearance time were significantly different between the frontal group (23.2±4.8 ml and 12.2±1.5 d, respectively) and the temporal group (26.7±5.8 ml and 13.8±1.8 d, respectively) (P<0.05). There were no significant differences in the 7-d postoperative residual hematoma volume, consciousness recovery time, postoperative rebleeding, and the length of hospital stay between the frontal and temporal groups (P>0.05). In addition, no significant difference was observed in the incidence of complications (10.4% vs 11.7%) and ADL score (55.1±17.3 vs 53.4±11.9) between the frontal and temporal groups, respectively (P>0.05).Conclusions Different minimally invasive drilling and drainage positions have an effect on early hematoma removal in patients with hypertensive intracerebral hemorrhage in the basal ganglia, where puncture direction parallel to the long axis of the basal ganglia hematoma resulted in better hematoma clearance in the frontal group. However, this positional difference is not associated with the incidence of complications and the quality of life in the patients.