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CT定位下微创穿刺 引流术治疗脑出血 的临床研究

作者:马兴顺 王 娜

所属单位:陕西省榆林市第一医院 (陕西 榆林 719000)

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摘要

目的 探讨CT定位对微创穿刺引 流术治疗脑出血的临床价值研究。方法 选取2013年1月-2015年1月在我院诊断治 疗的脑出血患者83例为研究对象,对患者 入院后多次CT扫描以及微创穿刺引流术 治疗临床资料进行综合分析。结果 83例 患者在CT定位下进行微创穿刺引流术, 术后首次血肿清除率小于20%有8例,20- 50%有19例,血肿清除率大于50%有56例, 50.6%(42/83)的患者血肿清除率较高。血 肿完全消除时间小于3天的有9例,3到8天 的有64例,血肿完全消除时间的大于8天 的有10例,87.9%(73/83)患者的血肿能在 8天内完全消除。根据CT影像,56例颅骨 钻孔或小骨窗定位准确。结论 CT扫描能 有效的对脑出血的部位、血量等进行评 估,极大减小了微创穿刺引流术治疗脑出 血时导致大脑血管及分支处的损伤,以及 穿刺治疗时血管损伤的可能,在对患者进 行微创穿刺引流治疗的选择和定位提供精 准、可靠的信息,值得在临床应用中广泛 应用,是一种安全可靠、非常具有实用价 值的手段。

Objective To investigate the clinical value of minimally invasive puncture and drainage under CT in the treatment of cerebral hemorrhage. Methods 83 cases of cerebral hemorrhage in our hospital from January 2013 to January 2015 were selected as the subjects, and the clinical data of CT scanning and mini-invasive puncture and drainage were analyzed. Results 83 patients of cerebral hemorrhage undertook mini-invasive puncture and drainage under CT, 8 cases with the first hematoma clearance rate less than 20%, 19 cases with the rate of 20-50%, 56 cases with hematoma clearance rate more than 50%, 50.6% (42/83)patients with high hematoma removal rate. There were 9 cases with hematoma clearance time less than 3 days, 64 cases with hematoma clearance time from 3 to 8 days, 10 cases with hematoma clearance time over 8 days, and 87.9% (73/83) patients' hematoma were completely eliminated in 8 days. According to the CT images, 56 cases of skull drilling or small bone window were located accurately. Conclusion CT scan can effectively get the exact location of bleeding and calculate the volume of the intracerebral hemorrhage, which reduced the damage to the blood vessels in the brain and branches when using minimally invasive puncture drainage for treatment of cerebral hemorrhage, and reduced the possibility of vascular injury greatly. It provides accurate and reliable information for patients to undertake minimally invasive puncture drainage treatment and to choose of the puncture location, which is widely used in clinical application. It is a safe, reliable methods which has practical value.

【关键词】CT扫描;微创穿刺引流术;脑 出血;诊断

【中图分类号】R493

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.09.012

前言

脑出血是指非外伤性脑实质内脑大、小动脉,静脉和毛细血管破 裂引起的脑内出血。包括自发性和被动性的。在欧美国家,脑出血患 者占全部卒中患者的10%~20%,病死率和致残率都很高。在我国,根 据2005年中国脑血管病防治指南,脑出血发病率为60~80/10万人口/ 年,占全部卒中病例的30%左右[1-2]。脑出血严重影响患者生活质量, 因此早期诊断和及时治疗对于脑出血患者的预后意义重大。随着微创 穿刺引流术的发展,以逐渐成为治疗脑出血的一重要治疗手段[3-7]。本 文回顾性分析2013年1月~2015年1月经我院治疗的83例脑出血患者的 CT诊断资料及临床资料,分析了微创穿刺引流术前后脑出血的CT影像 特征及治疗结果,现做报告如下。