摘要：

目的 探讨 CT 实时引导下血肿穿刺置管引流术治疗脑出血的有效性和安全性。方法 共80例出血量为15 ~ 30 ml的幕上出血患者分别予药物保守治疗（40例，包括6例出血量15 ~ 20 ml患者和 34 例出血量 > 20 ~ 30 ml 患者）和 CT 实时引导下血肿穿刺置管引流术（40 例，出血量 > 20 ~ 30 ml），分别于入院时和发病后 3 d 采用 Glasgow 昏迷量表（GCS）评价意识状态，入院时和出院时采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能缺损程度，记录住院时间和并发症（包括再出血、癫 、颅内感染、严重肺部感染、上消化道应激性溃疡伴出血等）。结果 两组患者发病后 3 d GCS 评分（P = 0.000）和出院时 NIHSS 评分（P = 0.000）均低于入院时；手术组患者 GCS 评分高于（P = 0.003）、NIHSS 评分低于（P = 0.000）对照组。手术组患者住院时间短于对照组［（10.53 ± 2.64）d 对（17.30 ± 4.92）d；t = 7.673，P = 0.000］。两组均未出现再出血、颅内感染、严重肺部感染、上消化道应激性溃疡伴出血等并发症。结论 对于出血量为 15 ~ 30 ml 的幕上出血患者，采用 CT 实时引导下血肿穿刺置管引流术可以缩短住院时间，减轻脑水肿高峰期反应，改善预后。

关键词: 脑出血, 引流术, 体层摄影术, X 线计算机

Abstract:

Objective To study the efficacy and safety of hematoma puncture catheter drainage under CT real-time guide for treatment of intracerebral hemorrhage (ICH). Methods A total of 80 ICH patients with hematoma volume 15-30 ml were given conservative treatment (control group, 40 cases including 6 cases with hematoma volume 15-20 ml and 34 cases with hematoma volume > 20-30 ml) and hematoma puncture and catheter drainage under CT real-time guide (operation group, 40 cases with hematoma volume > 20-30 ml). Conscious states were evaluated by Glasgow Coma Scale (GCS) on admission and 3 d after onset. Neurological deficits of patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission and discharge. Hospitalization days and complications (including rebleeding, epilepsy, intracranial infection, severe pulmonary infection and bleeding caused by digestive tract stress ulcer) were recorded. Results The GCS scores 3 d after onset (P = 0.000) and NIHSS scores on discharge (P = 0.000) of 2 groups were significantly lower than those on admission. The GCS score of operation group was significantly higher (P = 0.003) and NIHSS score was significantly lower (P = 0.000) than that of control group. The hospitalization time of operation group was significantly lower than those of control group [(10.53 ± 2.64) d vs. (17.30 ± 4.92) d; t = 7.673, P = 0.000]. Complications including rebleeding, intracranial infection, severe pulmonary infection and bleeding caused by digestive tract stress ulcer did not occur in patients of 2 groups. Conclusions For supratentorial hemorrhage patients withhematoma volume 15-30 ml, in comparison with conservative treatment, operation with hematoma puncture and catheter drainage under CT real-time guide can save hospitalization days, relieve edema peak response and improve the prognosis.

Key words: Cerebral hemorrhage, Drainage, Tomography, X-ray computed