CT定向软通道技术治疗基底核区高血压脑出血的近期病死率及预后研究

目的研究CT定向软通道技术对基底核区高血压脑出血患者的近期病死率及预后的影响。方法选择我院2008年3月—2010年10月经CT证实为基底核区出血且量在25～60 ml的高血压脑出血患者133例,其中内科治疗42例(保守组),开颅血肿清除术治疗45例(手术组),CT定向软通道技术治疗46例(微创组)。比较3组患者3个月内病死率、颅外并发症及日常生活活动能力(ADL)。结果保守组42例患者中死亡7例(16.7%),手术组45例患者中死亡6例(13.3%),微创组46例患者中死亡1例(2.2%),3组患者的病死率间差异有统计学意义(P<0.05),微创组的病死率明显低于保守组和手术组,差异均有统计学意义(P<0.05)。3组患者颅外并发症发生率比较差异均有统计学意义(P<0.05),其中微创组患者的颅外并发症发生率明显低于保守组和手术组(P<0.05)。微创组ADL 1～3级患者明显多于保守组和手术组(P<0.001)。结论 CT定向软通道技术治疗基底核区高血压脑出血操作简便、定位准确、创伤小,术后病死率低、颅外并发症少,患者生活质量得到提高。

Transcranial Puncture under CT Locating in Treating Basal Ganglia Hemorrhage:Short-term Mortality and Prognosis

Objective To determine the short-term mortality rate and the prognosis of basal ganglia hemorrhage treated by transcranial puncture under CT locating.Methods Totally 133 cases diagnosed with basal ganslia hemorrhage and hospitalized in our hospital from March 2008 to October 2010(the volume of hemorrhage 25~60 ml) were assigned to receive conservative therapy(conservative group;n=42),traditional craniectomy(surgical group,n=45),or transcranial puncture under CT locating(minimally invasive group;n=46).The mortality rate,extracranial complications(e.g.respiratory tract infection,urinary tract infection,alimentary tract bleeding,hyponatremia,renal insufficiency,and brain heart syndrome),and ability of daily life(ADL) were compared between these three groups within three months after treatment.Results The mortality rate in the minimally invasive group(2.2%;1/46) was significantly lower than that in the conservative group(16.7%;7/42) and in surgical group(13.3%;6/42)(P<0.05).The incidences extracranial complications were also significantly lower in the minimally invasive group than in the other two groups(P<0.05).There were significantly more patients at ADL grade 1~3 in the minimally invasive group than in the other two groups(P<0.001).Conclusion The transcranial puncture under CT locating has many advantages including good curative effect,simple operation,accurate positioning,small trauma,low short-term mortality,and mild extracranial complications,in treating basal ganglia hemorrhage,and thus can greatly improve the quality of life of the patients.