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神经导航引导下无框架立体定向穿刺引流治疗脑干出血的临床疗效及治疗经验 被引量:10

Clinical Effect and Treatment Experience of Frameless Stereotactic Puncture and Drainage under Neuronavigation in the Treatment of Brainstem Hemorrhage
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摘要 背景目前,有效清除血肿仍是脑干出血患者的治疗难题之一。近年随着神经导航系统和立体定向系统的不断完善,其因简便、创伤小、快捷等优势而在脑干出血患者治疗中得到进一步实践。目的探讨神经导航引导下无框架立体定向穿刺引流治疗脑干出血的临床疗效,并总结治疗经验。方法选取2018年2月—2020年1月郑州大学第二附属医院神经外科收治的脑干出血患者48例,其中19例接受神经导航引导下无框架立体定向穿刺引流治疗(观察组),29例不同意手术而采取内科保守治疗(对照组)。比较两组患者入院时及治疗1周后格拉斯哥昏迷量表(GCS)评分;治疗后3个月患者存活情况及存活患者改良Rankin量表(mRS)分级;治疗2周血肿清除量。结果术后复查颅脑CT证实,引流管精准位于血肿腔内。两组患者入院时GCS评分比较,差异无统计学意义(P>0.05);观察组患者治疗1周后GCS评分高于对照组,治疗后3个月mRS分级优于对照组,治疗后3个月内死亡率低于对照组,治疗2周血肿清除量大于对照组(P<0.05)。结论采用神经导航引导下无框架立体定向穿刺引流治疗脑干出血是有效的,可在一定程度上降低患者死亡率、改善患者预后,但需要注意的是,手术时应合理选择穿刺路径、手术时机、血肿引流方式、引流管直径等。 Background At present,effective removal of hematoma is still one of the difficult problems in the treatment of patients with brainstem hemorrhage.In recent years,with the continuous improvement of neuronavigation system and stereotactic system,it has been further practiced in the treatment of patients with brainstem hemorrhage because of its advantages of simplicity,small trauma and quickness.Objective To explore the clinical effect of frameless stereotactic puncture and drainage under neuronavigation in the treatment of brainstem hemorrhage,and summarize the treatment experience.Methods From February 2018 to January 2020,48 patients with brainstem hemorrhage treated in the Department of Neurosurgery,the Second Affiliated Hospital of Zhengzhou University were selected,of which 29 patients received routine medical treatment as the control group and other 19 patients treated with frameless stereotactic puncture and drainage under neuronavigation as the observation group.Glasgow Coma Scale(GCS)scores at admission and one week after treatment,survival and modified Rankin Scale(mRS)grading of survivors three months after treatment,and hematoma clearance two weeks after treatment were compared between the two groups.Results Postoperative brain CT examination confirmed that the drainage tube was accurately located in the hematoma cavity.There was no significant difference in GCS score between the two groups at admission(P>0.05);GCS score of the observation group was higher than that of the control group one week after treatment,mRS grade was better than that of the control group three months after treatment,mortality within three months after treatment was lower than that of the control group,and hematoma clearance two weeks after treatment was greater than that of the control group(P<0.05).Conclusion It is effective that frameless stereotactic puncture and drainage under neuronavigation in the treatment of brainstem hemorrhage,which can reduce the mortality and improve the prognosis of patients to a certain extent.But
作者 韩昊锦 牛光明 刘展 娄金峰 HAN Haojin;NIU Guangming;LIU Zhan;LOU Jinfeng(Department of Neurosurgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)
出处 《实用心脑肺血管病杂志》 2021年第3期85-90,共6页 Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词 脑干出血 神经导航 无框架立体定向 穿刺和引流 治疗结果 治疗经验 Brainstem hemorrhage Neuronavigation Frameless stereotactic Puncture and drainage Treatment outcome Treatment experience
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