立体定向手术抽吸与内科综合治疗脑出血后血肿周边水肿的疗效及预后比较

摘要

目的 观察立体定向术结合尿激酶引流对高血压脑出血患者血肿周边水肿程度及预后的影响.方法 以手术抽吸结合尿激酶引流治疗基底节区脑出血患者48例(立体定向组),以降颅压、控制血压、改善脑代谢、神经营养等内科常规治疗48例(内科治疗组)为对照.观察治疗后1周、2周、1个月和6个月时血肿周边水肿体积或软化灶、格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)分级、血肿消失时间及并发症发生情况.结果 与内科治疗组比较,立体定向组患者治疗后1周、2周血肿周边水肿或软化灶明显缩小[1周:(7.81±1.73) ml比(15.56±2.42) ml;2周:(6.42±1.51) ml比(13.37±1.76) ml,均P<0.01];GCS 14～15分患者例数明显增多(1周:41例比32例;2周:46例比40例,均P<0.05);治疗后2周、1个月GOS Ⅳ～Ⅴ级患者的例数明显增加(2周:15例比6例;1个月:29例比17例,均P<0.05);血肿消失时间明显缩短[(4.3±1.3) d比(23.3±7.9) d,P<0.01].结论 立体定向手术结合尿激酶引流可使脑出血患者早期血肿周边水肿明显减轻,意识状态及功能预后明显改善,而且有利于患者中长期预后的改善.%Objective To observe the perihematomal brain edema and outcome in patients with hypertensive intracerebral hemorrhage treated by stereotactic aspiration combined with instillation of urokinase. Methods Forty-eight cases with basal ganglia hematoma were treated by stereotactic aspiration combined with instillation of urokinase (surgical group), and another 48 cases were treated conservatively as control (conservative group) by conventional medical methods of lowering intracranial pressure, decreasing blood pressure, improving cerebral metabolism and neurotrophy, etc. The volume of the perihematomal brain edema (or the cerebral malacia), Glasgow coma scale (GCS) score, Glasgow outcome scale (GOS) score, the time span of hematoma disappearance and complications at 1-week, 2-week, 1-month and 6-month after treatment were observed and analyzed. Results Compared with the conservative group, perihematomal brain edema or the focus of cerebral malacia was significantly reduced at 1-week, 2-week [1-week: (7. 81±1.73) ml vs. (15. 56±2.42) ml, 2-week: (6.42±1.51) ml vs. (13.37±1.76) ml, both P＜0. 01], and patients with GCS 14 - 15 were obviously increased in surgical group (1-week: 41 cases vs. 32 cases; 2-week: 46 cases vs.40 cases, both P＜0. 05); cases with GOS Ⅳ- Ⅴ were markedly increased at 2-week, 1-month after treatment in surgical group (2-week: 15 cases vs. 6 cases; 1-month: 29 cases vs. 17 cases, both P＜0. 05); time span of hematoma disappearance was significantly reduced in surgical group [(4. 3±1. 3) days vs. (23. 3± 7. 9) days,P ＜0.01]. Conclusion In patients with intracerebral hemorrhage, perihematomal brain edema,consciousness, neural function and outcome in early stage can be significantly improved by stereotactic aspiration combined with instillation of urokinase, that are helpful to the outcome in long-term stages.