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 drainage 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 divided 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 hematoma 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 significantly 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 hematoma eliminating time and hospitalization days, with little injury and better clinical efficacy than conservative treatment, which further promotes early rehabilitation of nerve function.