| 邱 锋,费智敏,蔡佩浩,龚 立,孔令军,许乐宜.神经导航辅助下神经内镜血肿清除术治疗高血压脑出血的疗效及预后的影响因素分析[J].,2024,(7):1271-1275 |
| 神经导航辅助下神经内镜血肿清除术治疗高血压脑出血的疗效及预后的影响因素分析 |
| Analysis of the Efficacy and Prognostic Factors of Neuronavigation-Assisted Neuroendoscopic Hematoma Evacuation Operation in the Treatment of Hypertensive Intracerebral Hemorrhage |
| 投稿时间：2023-11-06 修订日期：2023-11-28 |
| DOI：10.13241/j.cnki.pmb.2024.07.013 |
| 中文关键词: 高血压脑出血 神经内镜 血肿清除术 神经导航辅助 疗效 预后 影响因素 |
| 英文关键词: Hypertensive intracerebral hemorrhage Nneuroendoscopic Hematoma evacuation operation Nneuronavigation-assisted Efficacy Prognosis Influence factors |
| 基金项目:上海市卫生健康委先进适宜技术推广项目（2019SY017） |
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| 中文摘要: |
| 摘要 目的：探讨神经导航辅助下神经内镜血肿清除术治疗高血压脑出血（HICH）的疗效，并分析预后的影响因素。方法：回顾性分析2019年2月~2022年6月期间上海中医药大学附属曙光医院收治的204例HICH患者的临床资料。根据手术方式的不同将患者分为A组（n=81，接受微创血肿穿刺引流术）和B组（n=123，接受神经导航辅助下神经内镜血肿清除术）。对比两组围术期相关指标以及术后并发症发生情况。随访1年，观察接受神经导航辅助下神经内镜血肿清除术患者术后1年的预后不良发生率，根据不同预后情况将患者分为预后不良组、预后良好组。收集HICH患者的临床资料，采用多因素Logistic回归分析预后的影响因素。结果：B组术中出血量少于A组，手术时间、住院时间短于A组，血肿清除率高于A组（P<0.05）。B组的术后并发症总发生率低于A组（P<0.05）。单因素分析结果显示，神经导航辅助下神经内镜血肿清除术患者预后不良与年龄、高血压病程、出血量、术前格拉斯哥昏迷指数（GCS）评分、肺部感染、血肿清除率、中线偏移、脑脊液循环通畅时间、发病至手术时间有关（P<0.05）。多因素Logistic回归分析结果显示，术前GCS评分偏低、年龄偏大、有肺部感染、高血压病程偏长、有中线偏移、出血量偏多均是神经导航辅助下神经内镜血肿清除术患者预后不良的危险因素，而发病至手术时间越短则是保护因素（P<0.05）。结论：与微创血肿穿刺引流术相比，神经导航辅助下神经内镜血肿清除术治疗HICH，可提升临床疗效，降低并发症发生率。年龄、高血压病程、出血量、术前GCS评分、肺部感染、中线偏移、发病至手术时间等是神经导航辅助下神经内镜血肿清除术患者预后的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the efficacy of neuronavigation-assisted neuroendoscopic hematoma evacuation operation in the treatment of hypertensive intracerebral hemorrhage (HICH), and to analyze the influencing factors of prognosis. Methods: The clinical data of 204 HICH patients who were admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from February 2019 to June 2022 were retrospectively analyzed. Patients were divided into group A (n=81, receiving minimally invasive hematoma puncture and drainage operation) and group B (n=123, receiving neuronavigation-assisted neuroendoscopic hematoma evacuation operation) according to the different surgical methods. The perioperative related indicators and postoperative complications were compared between two groups. After 1 year of follow-up, the incidence of poor prognosis in receiving neuronavigation-assisted neuroendoscopic hematoma evacuation operation patients after 1 year was observed, the patients were divided into poor prognosis group and good prognosis group according to different prognosis. The clinical data of HICH patients were collected, and the influencing factors of prognosis were analyzed by multivariate Logistic regression. Results: The intraoperative blood loss in group B was less than that in group A, the operation time and hospitalization time were shorter than those in group A, and the hematoma clearance rate was higher than that in group A (P<0.05). The total incidence of postoperative complications in group B was lower than that in group A (P<0.05). Univariate analysis showed that, the poor prognosis of patients undergoing neuronavigation-assisted neuroendoscopic hematoma evacuation operation was related to age, duration of hypertension, amount of bleeding, preoperative Glasgow Coma Scale (GCS) score, pulmonary infection, hematoma clearance rate, midline shift, cerebrospinal fluid circulation patency time and time from onset to operation (P<0.05). Multivariate Logistic regression analysis showed that, lower preoperative GCS score, older age, pulmonary infection, longer duration of hypertension, midline shift and more amount of bleeding were all risk factors for poor prognosis in patients undergoing neuronavigation-assisted neuroendoscopic hematoma evacuation operation, while the shorter time from onset to operation was a protective factor(P<0.05). Conclusion: Compare with minimally invasive hematoma puncture and drainage operation, neuronavigation-assisted neuroendoscopic hematoma evacuation operation for HICH, which can improve clinical efficacy and reduce the incidence of complications. Age, duration of hypertension, amount of bleeding, preoperative GCS score, pulmonary infection, midline shift, and time from onset to operation were the influencing factors for the prognosis of patients undergoing neuronavigation-assisted neuroendoscopic hematoma evacuation operation. |
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