论著-头颈部
CT引导下微创血肿 清除术治疗基底节 区自发性脑出血的 临床观察
作者:乔 鹏1 闫东明2
所属单位:1.河南科技大学第一附属医院神经 外科 (河南 洛阳 471023) 2.郑州大学第一附属医院神经外科 (河南 郑州 450000)
PDF摘要
目的 探讨电子计算机断层扫描 (CT)引导下微创血肿清除术治疗基底节 区自发性脑出血的应用价值。方法 选取 102例自发性脑出血患者,依据治疗方法 分组分为CT组(n=51)和内科组(n=51), 内科组给予内科保守治疗,CT组在内科 组治疗基础上给予CT引导下微创血肿清 除术,观察两组临床疗效。结果 CT组和 内科组的临床总有效率分别为88.24%和 72.55%(P<0.05),住院期间并发症率分 别为5.88%和7.84%(P>0.05),随访期间 存活率分别为100%和92.16%(P<0.05);与 治疗前相比,两组治疗后2w、4w的血肿体 积逐渐减少(P<0.05),组间及组内治疗 后不同时间点差异显著(P<0.05);与治 疗前相比,两组治疗后2w及4w的NIHSS评 分逐渐降低、Barthel指数评分逐渐增高 (P<0.05),组内及组间治疗后不同时间点 上述评分差异显著(P<0.05)。结论 CT引 导下微创血肿清除术具有靶向定位精准、 降低术后神经损伤等并发症及死亡风险、 血肿清除率高等优点,应用于基底节区自 发性脑出血治疗中疗效显著,可有效改善 患者神经损伤,利于其日常生活活动能力 提高,临床应用价值高。
Objective To explore the application values of computed tomography (CT)- guided minimally invasive evacuation of hematoma in the treatment of spontaneous intracerebral hemorrhage in basal ganglia. Methods 102 patients with spontaneous intracerebral hemorrhage were divided into the CT group (n=51) and the internal medicine group (n=51) according to the treatment methods. The internal medicine group was given the internal medicine conservative treatment, and the CT group was given the CT-guided minimally invasive evacuation of hematoma on this basis. The clinical efficacy of the two groups was observed. Results The total effective rates of the CT group and the internal medicine group were 88.24% and 72.55% respectively (P<0.05), and the complications rates during hospitalization were 5.88% and 7.84% respectively (P>0.05), and the survival rates during follow-up were 100% and 92.16% (P<0.05). Compared with before treatment, the hematoma volume was decreased gradually at 2w and 4w after treatment (P<0.05), and there were significant differences between-groups and withingroups at different time points after treatment (P<0.05). Compared with before treatment, the NIHSS score at 2w and 4w after treatment was decreased gradually while the Barthel index score was gradually increased (P<0.05), and there were significant differences in the above scores between-groups and within-groups at different time points after treatment (P<0.05). Conclusion CT-guided minimally invasive evacuation of hematoma has the advantages of precise targeting, reducing risk of postoperative complications and death such as nerve injury, and high hematoma clearance rate. It hs significant efficacy in the treatment of patients with spontaneous intracerebral hemorrhage in basal ganglia, and can effectively improve the nerve injury, and it is conducive to the improvement of their daily living activities, and it has high clinical application values.
【关键词】电子计算机断层扫描;微创血 肿清除术;基底节区自发性脑 出血
【中图分类号】R743.34
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2018.06.012
前言
脑出血是发病、致残及死亡率极高的神经内科常见疾病,发病主 要与脑血管病变有关,患者出血部位多发于基底节区,是影响其预后 结局的重要危险因素[1]。清除颅脑血肿是改善脑损伤的关键,临床多 采用内科保守和手术治疗,虽然内科保守治疗水平不断提高,但脑血 肿清除效果仍不理想,而传统开颅血肿清除术虽可彻底清除脑血肿, 但具有创伤性大、术中风险高、术后并发症多等劣势,均不宜作为颅 脑血肿清除的首选治疗方式[2]。随着医学影像技术的不断进步,外科 微创理念不断深入,使得电子计算机断层扫描(CT)引导下微创血肿清 除术受到医患的关注及青睐。CT引导下的微创血肿清除术可精准定位 颅脑出血点,详尽反映病变周边局解关系[3],故本文探讨CT引导下微 创血肿清除术治疗基底节区自发性脑出血的临床疗效,现进行如下描 述。
中国CT和MRI杂志
第16卷, 第 6 期
2018年06月
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