利用CTA“点状征”指导中等量高血压脑出血手术方式的选择

Selection of surgical procedures for moderate hypertensive intracerebral hemorrhage in the basal ganglia guided by CTA “spot sign”

摘要:

目的 根据CTA"点状征"是否存在对脑出血分类，研究开颅血肿清除术和钻孔引流术治疗中等量（30ml~60ml）高血压基底节区脑出血的疗效，探讨手术方式的选择。方法 选择中等量高血压基底节区脑出血166例，根据是否存在CTA"点状征"分为两类。每种类型的脑出血再次随机分为两组，分别行开颅血肿清除术和钻孔引流术治疗。比较CTA"点状征"阳性及阴性病例经过不同手术方式治疗后的再出血率、死亡率、发病后90d的改良Rankin评分（mRS）及日常生活能力评分（Barthel指数），对两种手术方式进行评价，探讨中等量脑出血手术方式的选择。结果 对于CTA"点状征"阳性病例，钻孔引流术组的再出血率、死亡率均高于开颅手术组（P<0.05），生活依赖性比例（mRS>2）及预后良好比例（Barthel指数≥ 90）的差异无统计学意义。对于CTA"点状征"阴性病例，两组的再出血率、死亡率、生活依赖性比例及预后良好比例的差异均无统计学意义。结论 对于CTA"点状征"阳性病例，适宜行开颅手术治疗，能够降低再出血率及死亡率。对于CTA"点状征"阴性病例，适宜行钻孔引流术治疗，操作简单，创伤较小。两种手术方式对于存活患者的预后影响没有差异。术前对病人进行合理的分类是必要的，CTA"点状征"为我们提供了一种良好的分类依据。

Abstract:

Objective To compare the efficacy of craniotomy and puncture drainage in the treatment of moderate (30-60 ml) hypertensive intracerebral hemorrhage (ICH) in the basal ganglia and to investigate the selection of reasonable surgical procedures.Methods A total of 166 patients with moderate hypertensive ICH in the basal ganglia were divided into two groups (positive group and negative group) according to the presence or absence of computed tomography angiography (CTA) "spot sign". Patients in each group were randomly divided into craniotomy subgroup and puncture drainage subgroup. The rebleeding rate, mortality, modified Rankin Scale (mRS) score, and Barthel Index (BI) of activity of daily living at 90 days after onset were compared between the two subgroups in the positive and negative groups.Results For the positive group, the puncture drainage subgroup had significantly higher rebleeding rate and mortality than the craniotomy subgroup (P<0.05); there were no significant differences in the proportion of dependent survival patients (mRS score >2) and the proportion of patients with good prognosis (BI ≥ 90) between the two subgroups (P>0.05). For the negative group, there were no significant differences in rebleeding rate, mortality, the proportion of dependent survival patients, and the proportion of patients with good prognosis between the two subgroups (P>0.05).Conclusions For patients with moderate (30-60 ml) hypertensive ICH in the basal ganglia, craniotomy is suitable for patients with CTA "spot sign" to reduce the rebleeding rate and mortality; puncture drainage is suitable for patients without CTA "spot sign" due to its advantages of simple operation and minimal invasion. There is no significant difference in the prognosis of patients between the two surgical procedures. So it is necessary to classify patients before surgery according to the presence or absence of CTA "spot sign".