CT引导微创抽吸引流术治疗颅内血肿的疗效及影响因素分析

目的探讨影响CT引导微创抽吸引流术后病死率的危险因素,并评估其治疗颅内血肿的疗效。方法对87例幕上脑出血患者,以YL1型颅内血肿穿刺针行血肿微创抽吸引流术,前瞻性观察患者术后病死率,同时对年龄、血肿部位、血肿量、GCS积分、脑中线结构移位、手术时机、首次血肿清除率、血压控制、引流后残余血肿量以及并发症等因素相关的死亡分布进行统计学分析。结果微创抽吸引流术后患者病死率与血肿量、GCS积分和中线结构移位程度有相关性(P<0.05),而与年龄、血肿部位、入院血压、手术时机、引流后残余血肿量、首次血肿清除率和并发症之间无显著相关性(P>0.05);再出血的发生率较高,但和药物降压治疗无关(P>0.05)。结论血肿量、GCS积分和中线结构移位程度是影响微创抽吸引流术治疗颅内血肿疗效的主要因素,术前相应指征的选择对提高手术疗效及改善预后有重要价值。

Evaluation of the therapeutic effect of CT-guided microinvasive aspiration and drainage on patients with intracerebral hemorrhage

Objective To investigate the risk factors associated with the postoperative mortality after CT-guided microinvasive aspiration and drainage therapy, and to evaluate the therapeutic effect of the therapy on patients with intracerebral hemorrhage.Methods The mortality of 87 patients with supratentorial spontaneous intracerebral hemorrhage was prospectively observed,who had received the CT-guided microinvasive aspiration and drainage therapy with the YL-1 puncture needle. The postoperative mortality and various factors were statistically analyzed respectively including age,hematoma location and volume, Glasgow coma scale (GCS) score,the shift of cerebral midline construct,operation time,the clearance rate of hematoma in the first time,blood pressure control,the residual hematoma volume postextubation and complications.Results The postoperative mortality of the CT-guided microinvasive aspiration and drainage therapy was correlated with the hematoma volume,GCS and the shift of cerebral midline construct (P<0.05),but not with age,hematoma location,operation time,the clearance rate of hematoma in the first time,blood pressure control,the residual hematoma volume postextubation and complications (P>0.05).The recurrent hemorrhage rate was higher than that of previous reports,which had nothing to do with the antihypertensive treatment (P>0.05).Conclusion The hematoma volume,GCS and the shift of cerebral midline construct are the leading factors related with the therapeutic effect of CT-guided microinvasive aspiration and drainage,which play important roles in the guidance of the operation indications and in improving the prognosis of patients with intracerebral hemorrhage.