CAJ | 학술논문

目的：研究中小量（15～40 ml）基底核区高血压性脑出血应用立体定向治疗与内科保守治疗对患者病死率、运动功能及预后的影响。方法2003年1月～2013年1月，我院收治中小量基底核区高血压性脑出血164例，其中82例行立体定向手术抽吸结合尿激酶引流治疗，另82例行内科保守治疗。比较2组血肿清除时间、30 d病死率、患侧肢体运动功能和90 d格拉斯哥预后评分（Glasgow outcome score，GOS）。结果立体定向治疗组血肿消散时间（3．8±1．1）d，明显短于内科治疗组的（19．9±3．5）d（t＝-39．463，P＝0．000）。2组30 d病死率差异无显著性。立体定向组治疗30 d病肢肌力4～5级[43．9％（36/82） vs．28．0％（23/82），χ2＝4．474， P＝0．034]和90 d GOS 5分者的比例明显高于内科治疗组[53．7％（44/82） vs．36．6％（30/82），χ2＝4．826， P＝0．028]。结论对于中小量高血压性脑出血，行立体定向手术治疗比内科治疗能明显加快血肿清除时间，改善患者的功能预后。
목적：연구중소량（15～40 ml）기저핵구고혈압성뇌출혈응용입체정향치료여내과보수치료대환자병사솔、운동공능급예후적영향。방법2003년1월～2013년1월，아원수치중소량기저핵구고혈압성뇌출혈164례，기중82례행입체정향수술추흡결합뇨격매인류치료，령82례행내과보수치료。비교2조혈종청제시간、30 d병사솔、환측지체운동공능화90 d격랍사가예후평분（Glasgow outcome score，GOS）。결과입체정향치료조혈종소산시간（3．8±1．1）d，명현단우내과치료조적（19．9±3．5）d（t＝-39．463，P＝0．000）。2조30 d병사솔차이무현저성。입체정향조치료30 d병지기력4～5급[43．9％（36/82） vs．28．0％（23/82），χ2＝4．474， P＝0．034]화90 d GOS 5분자적비례명현고우내과치료조[53．7％（44/82） vs．36．6％（30/82），χ2＝4．826， P＝0．028]。결론대우중소량고혈압성뇌출혈，행입체정향수술치료비내과치료능명현가쾌혈종청제시간，개선환자적공능예후。
Objective To evaluate the mortality rate , motor function and prognosis of small-and moderate-volume hypertensive cerebral hemorrhage in basal ganglia area treated by stereotactic surgery or conservative treatment . Methods From January 2003 to January 2013, 164 cases of small-and moderate-volume hypertensive cerebral hemorrhage in basal ganglia area were treated in our hospital .Of the 164 patients, 82 were treated with stereotactic surgery combined with instillation of urokinase , and 82 received conservative treatment .The hematoma clearance time , the mortality rate and motor function of the paralytic limbs at day 30 and the Glasgow outcome score ( GOS) at day 90 after the treatment were compared between the two groups . Results In stereotactic group, the dissipation time of hematoma (3.8 ±1.1 d) was significantly shorter than that in conservative group (19.9 ±3.5 d, t=-39.463, P=0.000).The mortality rate at day 30 after the treatment was not significantly different between the two groups .In stereotactic group , the rate of patients ’ diseased limb with muscle strength level 4-5 at day 30 and GOS scores of 5 points at day 90 after the treatment were significantly higher than those in conservative group [43.9% (36/82) vs.28.0% (23/82), χ2 =4.474, P=0.034; 53.7% (44/82) vs.36.6% (30/82), χ2 =4.826, P =0.028]. Conclusion For patients with intracerebral hematoma between 15 ml and 40 ml in volume, stereotactic surgery has shorter hematoma clearance time , less mortality rate and better prognosis of motor function .