局麻下钻孔引流术治疗基底节区中等量脑出血

Minimally invasive puncture drainage under local anesthesia in treatment of moderate basal ganglia hemorrhage

摘要:

目的 探讨局麻下微创钻孔引流术治疗基底节区中等量脑出血的临床特点和疗效。方法 回顾性分析该院于2019年6月—2020年6月收治的50例基底节区中等量脑出血患者(<50 mL)，按手术方式不同分为小骨窗开颅组和钻孔引流组各25例，记录两组的血肿清除率、住院时间、术后并发症、神经功能恢复等指标。结果 两组死亡率、术后再出血率、颅内感染率和出院时格拉斯哥昏迷量表（GCS）评分差异无统计学意义（P＞0.05）。钻孔组与开颅组血肿清除率、手术时间、住院时间、术后ICU入住时间、肺部感染率、气管切开率、术后1年改良Rankin量表（mRS）评分≤2所占比例比较，差异均有统计学意义（P＜0.05）。结论 局麻下微创钻孔引流术治疗基底节区中等量脑出血和开颅手术一样安全有效，不增加再出血和颅内感染风险，且患者术后肺部感染率和气管切开率更低，住院时间更短，同时远期神经功能恢复更佳。

Abstract:

Objective To investigate the clinical features of moderate basal ganglia hemorrhage and the efficacy of minimally invasive puncture drainage under local anesthesia.Methods A retrospective analysis was performed for 50 patients with moderate basal ganglia hemorrhage （<50 mL） who were admitted to our hospital from June 2019 to June 2020， and according to the surgical procedure， the patients were divided into small bone flap craniotomy group and puncture drainage group， with 25 in each group. Hematoma clearance rate， length of hospital stay， postoperative complications， and neurological function recovery were recorded for the two groups.Results There were no significant differences between the two groups in mortality rate， postoperative rebleeding rate， intracranial infection rate， and Glasgow Coma Scale score at discharge （P >0.05）， and there were significant differences between the puncture drainage group and the small bone flap craniotomy group in hematoma clearance rate， time of operation， length of hospital stay， duration of admission to the intensive care unit after surgery， pulmonary infection rate， rate of tracheotomy， and proportion of patients with a modified Rankin Scale score of ≤2 at 1 year after surgery （P <0.05）.Conclusions Minimally invasive puncture drainage under local anesthesia is as safe and effective as craniotomy in the treatment of moderate basal ganglia hemorrhage and does not increase the risk of rebleeding and intracranial infection， with lower rates of pulmonary infection and tracheotomy， a shorter length of hospital stay， and better long-term neurological function recovery.