应用客观指标规范化决策少量基底节出血手术指征的临床研究

A clinical study on the application of objective indicators to standardize the decision-making of surgical indications for small amounts of basal ganglia hemorrhage

摘要:

目的 评估血肿同侧内囊局部脑血流量(region cerebral blood flow,rCBF)这一客观指标在规范化决策少量(15-30mL)高血压性基底节出血(hypertensive basal ganglia hemorrhage,HBGH)手术指征中的应用价值。方法 回顾性分析198例少量基底节脑出血患者的病历资料,以入院时的CT灌注(CTperfusion,CTP)检查所测得的血肿同侧内囊区r CBF数值为标准分为轻度灌注不足组(rCBF≥15mL/(100g.min))103例,和重度灌注不足组(rCBF＜15mL/(100g.min))95例,在两组中再根据患者是否手术,分别分为手术亚组和保守亚组。对比两组中手术与保守2亚组间患者治疗效果的差异,以及术前术后内囊区rCBF差异,评价rCBF 在决策少量HBGH患者手术指征中的应用价值。结果 轻度灌注不足组手术亚组与保守亚组比较,治疗有效、预后良好、术后内囊区rCBF数值等差异无统计学意义,( P＞0.05) 重度灌注不足组手术亚组与保守亚组比较,治疗有效、预后良好、术后内囊区rCBF数值等差异有统计学意义。( P<0.05)。结论 在少量HBGH患者中,内囊区轻度灌注不足者,无手术指征。重度灌注不足者,手术可改善预后,有手术指征。内囊区rCBF可作为决策少量HBGH手术指征的客观指标。

Abstract:

Objective To analyze the value of regional cerebral blood flow (rCBF) as objective indicator in standardized determine the surgical indications of small volume (15-30mL) hypertensive basal ganglia hemorrhage. Methods The medical records of 198 patients with small volume basal ganglia intracerebral hemorrhage(HBGH) were retrospectively analyzed. Based on the value of rCBF in the ipsilateral internal capsule area of the hematoma measured by CT perfusion (CTP) at admission, 103 patients were divided into mild hypoperfusion group (rCBF ≥ 15mL/(100g. min)) and95 patients into severe hypoperfusion group (rCBF<15mL/(100g. min)). According to whether the patients were operated, the two groups were divided into surgical subgroup and conservative subgroup. To compare the difference of treatment effect between the two groups, as well as the difference of rCBF in the internal capsule area before and after surgery, and to evaluate the application value of rCBF in deciding the surgical indications of patients with small amount of basal ganglia intracerebral hemorrhage. Results Compared with the conservative subgroup, the operative subgroup in the mild hypoperfusion group had no significant difference in terms of effective treatment, good prognosis, and postoperative rCBF value in the internal capsule area. (P>0.05) Compared with the conservative subgroup, the operative subgroup in the severe hypoperfusion group had significant difference in terms of effective treatment, good prognosis, and postoperative rCBF value in the internal capsule area. ( P<0.05)。 Conclusion In patients with small amount of basal ganglia intracerebral hemorrhage, there is no indication for surgery if the internal capsule area is slightly perfused. In patients with severe insufficient perfusion, surgery can improve the prognosis and has surgical indications. The rCBF in the internal capsule area can be used as a objective standard to determine the surgical indications for small volume hypertensive basal ganglia intracerebral hemorrhage.