半球间裂胼胝体入路治疗重症丘脑出血的临床研究
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摘要
目的探讨半球间裂胼胝体入路治疗重症丘脑出血的临床效果。方法选择2013年2月—2018年12月期间收治的符合研究标准的46例重症丘脑出血患者,按照随机数字表法分为观察组(23例)与对照组(23例)。对照组采取传统手术方法进行治疗,观察组采取半球间裂胼胝体入路法治疗。观察并分析两组患者的手术时间、引流管留置时间、意识障碍恢复所需时间,比较术后日常生活能力评分(ADL)与格拉斯哥预后评分(GOS评分)情况,并比较两组术后并发症情况及临床总有效率。结果治疗后,与对照组比较,观察组患者手术时间、引流管留置时间、意识障碍恢复所需时间均降低显著(P <0. 05);治疗后两组患者ADL评分与GOS评分情况改善明显,且观察组评分改善情况优于对照组,差异有统计学意义(P <0. 05);经统计分析,观察组患者的并发症发生情况低于对照组,且临床总有效率(86. 96%)也明显高于对照组(56. 52%),差异有统计学意义(P <0. 05)。结论重症丘脑出血患者采用半球间裂胼胝体入路法进行治疗,临床疗效确切,创伤微小,血肿清除彻底,术后神经功能恢复情况优良,安全系数高,值得在临床工作中推广应用。
Objective To investigate the clinical effect of interhemispheric sacral approach for severe thalamic hemorrhage. Methods Forty-six patients with severe thalamic hemorrhage who met the study criteria were enrolled in our hospital from February 2013 to December 2018. The above patients were divided into observation group( n = 23) and control group( n = 23) with the random number table method. The control group was treated with conventional surgery,and the observation group with hemispherical sacral approach. The operation time,drainage tube indwelling time,and time to recovery of consciousness disorder were observed and analyzed. The postoperative daily life ability score( ADL) and Glasgow prognosis score( GOS score) were compared and the postoperative complications were compared between the two groups. Also,the complications and clinical total effective rate were compared between the two groups. Results After treatment,compared with the control group,the operation time,drainage tube indwelling time,and recovery time of consciousness disorder were significantly decreased in the observation group( P < 0. 05). Besides,the ADL score and GOS score of the two groups were improved significantly. The improvement of the observation group score was significantly better than that of the control group( P < 0. 05).After statistical analysis,the complication of the observation group was lower than that of the control group,and the total clinical effective rate( 86. 96%) was also obvious. Compared with the control group( 56. 52%),the difference was statistically significant( P < 0. 05). Conclusion Patients with severe thalamic hemorrhage are treated with hemispherical sacral approach. The clinical effect is exact,the trauma is small,the hematoma is completely removed,the postoperative neurological function is excellent,and the safety factor is high. It is worthy of popularization and application in clinical practice.
Objective To investigate the clinical effect of interhemispheric sacral approach for severe thalamic hemorrhage. Methods Forty-six patients with severe thalamic hemorrhage who met the study criteria were enrolled in our hospital from February 2013 to December 2018. The above patients were divided into observation group( n = 23) and control group( n = 23) with the random number table method. The control group was treated with conventional surgery,and the observation group with hemispherical sacral approach. The operation time,drainage tube indwelling time,and time to recovery of consciousness disorder were observed and analyzed. The postoperative daily life ability score( ADL) and Glasgow prognosis score( GOS score) were compared and the postoperative complications were compared between the two groups. Also,the complications and clinical total effective rate were compared between the two groups. Results After treatment,compared with the control group,the operation time,drainage tube indwelling time,and recovery time of consciousness disorder were significantly decreased in the observation group( P < 0. 05). Besides,the ADL score and GOS score of the two groups were improved significantly. The improvement of the observation group score was significantly better than that of the control group( P < 0. 05).After statistical analysis,the complication of the observation group was lower than that of the control group,and the total clinical effective rate( 86. 96%) was also obvious. Compared with the control group( 56. 52%),the difference was statistically significant( P < 0. 05). Conclusion Patients with severe thalamic hemorrhage are treated with hemispherical sacral approach. The clinical effect is exact,the trauma is small,the hematoma is completely removed,the postoperative neurological function is excellent,and the safety factor is high. It is worthy of popularization and application in clinical practice.
引文
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[17]王炬.高血压性丘脑出血破入脑室伴梗阻性脑积水的手术临床疗效及分析[D].郑州:郑州大学,2016.
[18]蔡利,王志勇,周毅,等.经纵裂-胼胝体入路治疗脑室出血并急性脑积水[J].中国临床医学,2012,19(2):126-127.
[19]张洪钿.经纵裂-胼胝体入路治疗丘脑出血[J].中华神经创伤外科电子杂志,2015,1(3):61-62.
[20]高睿.胼胝体入路治疗丘脑出血入脑室的临床研究[J].中国现代药物应用,2016,10(13):89-90.
[2]鲁春鹤,付振宇,宋宏伟,等.颅内压监测下脑室外引流治疗重型丘脑出血临床分析[J].临床军医杂志,2018,46(4):462-463.
[3]杨利辉,刘英彩,张建刚,等.神经内镜与小骨窗开颅治疗老年性丘脑出血的对比[J].中华神经外科疾病研究杂志,2018,17(3):273-274.
[4]梁其志,伍益,昌大平.定向软通道置软管血肿吸引术治疗高血压脑出血的疗效分析[J].现代医院,2018,18(1):96-97,101.
[5]涂博.双靶点软通道微创穿刺引流术对高血压丘脑出血术后血肿清除率及神经功能的影响[J].实用中西医结合临床,2017,17(12):50-52.
[6]周林强,王晓军,路阳,等.内镜辅助经胼胝体入路显微手术治疗重度丘脑出血伴脑室铸型[J].中华神经创伤外科电子杂志,2017,3(5):264-267.
[7]杨化强.探讨微创穿刺引流治疗高血压脑出血的临床疗效[J].中国实用医药,2017,12(22):6-8.
[8]阮航,段发亮,罗明,等.导航辅助内镜下手术治疗高血压性丘脑出血破入脑室[J].中国临床神经外科杂志,2017,22(7):491-492.
[9]齐宇,韩秀红,孙志博,等.胼胝体-侧脑室入路显微手术治疗丘脑出血[J].中国微侵袭神经外科杂志,2017,22(6):274.
[10]王笑笑,梁志金,梁梦颖,等.基于微信平台的延续护理对脑卒中患者影响的Meta分析[J].中国临床护理,2019,11(1):82-85.
[11]刘文明.微创穿刺技术在丘脑出血治疗中的应用效果分析[D].济南:山东大学,2018.
[12]李敏.软通道与硬通道微创介入术治疗高血压丘脑出血的临床疗效比较[J].临床合理用药杂志,2016,9(35):96-97.
[13]孙一为,李朝晖,苗壮,等.经纵裂胼胝体入路治疗重型内侧型丘脑出血[J].中国微侵袭神经外科杂志,2016,21(11):503-505.
[14]应建有,谭占国,袁波.脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血[J].中华神经创伤外科电子杂志,2015,1(5):21-24.
[15]刘荣财,黄强,戴伟民,等.经纵裂-胼胝体入路神经内镜辅助治疗重型脑室出血[A].//浙江省医学会神经外科学分会.2015浙江省神经外科学学术年会暨浙闽江赣四省神经外科学术交流会论文汇编[C].浙江省医学会神经外科学分会:浙江省科学技术协会,2015:1.
[16]蔚强,綦学强,吕俊生.立体定向钻孔引流术与小骨窗开颅术治疗老年高血压丘脑出血患者疗效观察[J].中华老年心脑血管病杂志,2016,18(6):645-646.
[17]王炬.高血压性丘脑出血破入脑室伴梗阻性脑积水的手术临床疗效及分析[D].郑州:郑州大学,2016.
[18]蔡利,王志勇,周毅,等.经纵裂-胼胝体入路治疗脑室出血并急性脑积水[J].中国临床医学,2012,19(2):126-127.
[19]张洪钿.经纵裂-胼胝体入路治疗丘脑出血[J].中华神经创伤外科电子杂志,2015,1(3):61-62.
[20]高睿.胼胝体入路治疗丘脑出血入脑室的临床研究[J].中国现代药物应用,2016,10(13):89-90.