立体定向穿刺引流术治疗少量高血压脑出血临床分析

目的：探讨少量基底节高血压脑出血内科保守治疗与 CT 引导立体定向穿刺引流术预后疗效。方法选取2011年5月至2014年6月收治的72例基底节高血压脑出血患者（出血量20~30 mL），分为保守治疗组和手术治疗组各36例，观察比较两组患者的治疗效果。结果两组患者并发症发生率比较，差异无统计学意义（11.4% vs 22.9%，P >0.05），均无死亡病例。手术治疗组平均血肿消除时间（4.8±1.9）d 明显短于保守治疗组（15.2±4.5）d，差异有统计学意义（P <0.05）；手术组住院时间（19.6±4.2）d 明显短于保守组（23.3±5.3）d，差异有统计学意义（P <0.05）。治疗后2周、1个月、3个月的美国国立卫生研究院卒中量表（NIHSS）评分两组均明显低于治疗前，且手术组术后2周、1个月的 NIHSS 评分均明显低于保守组，差异均有统计学意义（ P <0.05），但3个月后 NIHSS 评分比较，两组差异无统计学意义（P >0.05）。结论立体定向穿刺引流术治疗少量基底节高血压脑出血，创伤小，可以缩短血肿消除时间、减少患者住院时间，促进神经功能早期恢复，临床疗效优于内科保守治疗。

Clinical research on stereotactic puncture and drainage in treatment of small-volume hypertensive cerebral hemorrhage

Objective To compare the therapeutic effects of conservative treatment with CT-guided stereotactic puncture and drain-age in treatment of small-volume hypertensive basal ganglia hemorrhage. Methods 72 patients with small - volume hypertensive cerebral hemorrhage of basal ganglia ever treated from May 2011 to June 2014 were selected,the bleeding amount being 20 ~ 30 mL,and equally di-vided into operation treatment group and conservative treatment group for their contrast of therapeutic effects. Results No cases died,and no statistically difference were found in the incidence of complications(11. 4% vs 22. 9% ,P > 0. 05)between the two groups. The average he-matoma eliminating time and hospitalization days in the operation treatment group were(4. 8 ± 1. 9)d and(19. 6 ± 4. 2)d,which were both much shorter than those in the conservative treatment group,(15. 2 ± 4. 5)d and(23. 3 ± 5. 3)d,with statistically differences(P < 0. 05). The NIHSS(National Institute of Health stroke scale)scores of the two groups at 2 weeks,1 month or 3 months after treatment were signifi-cantly lower than those before treatment,and the NIHSS scores of the operation treatment group at 2 weeks or 1 month after treatment were significantly lower than those of the conservative treatment group,and the differences between them were statistically significant(P < 0. 05). There was no significant difference in the NIHSS scores at 3 months after treatment between the two groups(P > 0. 05). Conclusion Use of stereotactic puncture and drainage in treatment of small-volume hemorrhage of basal ganglia caused by hypertension is effective to shorten he-matoma eliminating time and hospitalization days,with little injury and better clinical efficacy than conservative treatment,which further pro-motes early rehabilitation of nerve function.