[1]孙伟,钱忠心,赵鸿,等.微创治疗高血压性脑出血对皮质脊髓束及预后的影响[J].临床神经外科杂志,2016,(03):220-223.
 SUN Wei,QIAN Zhong-xin,ZHAO Hong,et al.Influence of minimally invasive removal of hypertensive intracerebral hematoma on corticospinal tract and outcome[J].Journal of Clinical Neurosurgery,2016,(03):220-223.
点击复制

微创治疗高血压性脑出血对皮质脊髓束及预后的影响()
分享到:

《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
期数:
2016年03期
页码:
220-223
栏目:
临床研究
出版日期:
2016-06-10

文章信息/Info

Title:
Influence of minimally invasive removal of hypertensive intracerebral hematoma on corticospinal tract and outcome
作者:
孙伟钱忠心赵鸿龚良刘向阳刘卫东
200125上海市浦东新区浦南医院神经外科
Author(s):
SUN WeiQIAN Zhong-xinZHAO Honget al.
Department of Neurosurgery,Shanghai Punan Hospital of Pudong New District,Shanghai 200125,China
关键词:
高血压性脑出血弥散张量成像皮质脊髓束微创手术
Keywords:
hypertensive intracerebral hemorrhagediffusion tensor imagingcorticospinal tractminimally invasive surgery
文献标志码:
D
摘要:
目的:探讨弥散张量成像(DTI)观察皮质脊髓束(CST)受损对评估高血压性脑出血(HICH)预后的价值,以及微创治疗改善其预后的效果。方法:43例HICH(出血量20~40 ml)患者随机分为保守治疗组和微创手术组;微创手术组患者行神经导航下钻孔引流术。分别于患者发病时(术前)和发病3个月后进行DTI检查和美国国立卫生研究院卒中量表(NIHSS)评分。用平均部分各向异性(FA)测量患侧血肿层面周围及对侧的CST,计算患侧/对侧的FA值比率。结果:发病时,微创手术组与保守治疗组的FA值比率比较,差异无统计学意义。发病时与发病3个月后的FA值比率比较,保守治疗组的差异无统计学意义;而微创手术组的差异有统计学意义(P<0.05)。发病3个月后,两组的FA值比率比较,差异无统计学意义;但如除去CST4级病例,两组CST1~3级患者的差异有统计学意义(P<0.05)。CST完整患者的NIHSS评分在各个时期均较CST中断的患者好。结论:HICH(中小量)患者微创治疗的效果大多优于保守治疗,但CST4级患者无论采取何种治疗的预后都不好;对CST1~3级患者早期微创手术治疗可以改善预后,提高生活质量。
Abstract:
Abstract:Objective: To evaluate the influence of minimally invasive removal of hypertensive intracerebral hematoma (HICH) on corticospinal tract(CST).Methods:Diffusion tensor imaging(DTI) was performed in 43 patients with intracerebral hemorrhage within several hours after onset.43 patients with HICH were randomly divided into conservative and minimally invasive surgery group.Mean fractional anisotropy (FA) values along the corticospinal tracts at the level of the hematoma were measured bilaterally,and the ratios of values (hematoma side/contralateral side) were determined as FA.All patients underwent DTI examination at admission and 3 months before and after surgery,and national institutes of health stroke scale(NIHSS) score was also performed.Results:the FA ratio of HICH patients was compared.The results showed that there was no significant difference between the FA value of the minimally invasive group and the conservative group at the onset of HICH,and the FA ratio in the followup of the patients was not statistically significant;the FA value of the conservative group was not statistically significant;the FA value of the operation group was statistically significant.However,in comparison of FA values in the followup period,the conservative group and operation group had no significant difference,if there were no significant differences between the 2 groups.The muscle strength and NIHSS score of patients with CST13 were better than those of patients with CST4.Conclusion:In patients with hypertensive intracerebral hemorrhage(20-40 ml),the effects of minimally invasive treatment group is better than that of the conservative treatment group,but for patients with CST4,no matter what kind of treatment,prognosis is not good;for patients with 1-3 grade,early minimally invasive surgical treatment can improve the prognosis and improve the life.

相似文献/References:

[1]刘宏毅,张玉海,邹元杰,等.弥散张量面神经成像技术在大型听神经瘤术中面神经定位的可行性研究[J].临床神经外科杂志,2015,(01):36.
[2]倪春霞,汪洋,盛晓芳.应用DWI和DTI勾画在高级别胶质瘤术后放疗靶区的初步研究[J].临床神经外科杂志,2015,(03):223.
[3]邢涛,付志辉,张荣俊,等.高血压脑出血患者偏瘫相关弥散张量成像研究[J].临床神经外科杂志,2014,(04):255.
[4]张玉海,刘宏毅,张锐,等.多模态影像联合电生理监测在脑功能区胶质瘤手术中的应用研究[J].临床神经外科杂志,2016,(05):335.
 ZHANG Yu-hai,LIU Hong-yi,ZHANG Rui,et al.Application of multimodal neurological imaging and neurophysiological monitoring in surgical resection for eloquently located cerebral gliomas[J].Journal of Clinical Neurosurgery,2016,(03):335.
[5]丁永宏,梁成,邵文生,等.弥散张量成像在高血压脑出血患者预后评估中的应用[J].临床神经外科杂志,2017,14(01):65.
 DING Yong-hong,LIANG Cheng,SHAO Wen-sheng,et al.Application of diffusion tensor imaging for evaluation of the prognostic factors in patients with hypertensive intracerebral hemorrhage[J].Journal of Clinical Neurosurgery,2017,14(03):65.
[6]金祝华,匡永勤,李天泉,等.中性粒细胞弹性蛋白酶抑制剂对脑出血患者术后氧化应激、炎性介质的影响[J].临床神经外科杂志,2018,15(03):213.
 JIN Zhu-hua,KUANG Yong-qin,LI Tian-quan,et al.Effects of neutrophil elastase inhibitor on oxidative stress and inflammatory mediators in patients with intracerebral hemorrhage[J].Journal of Clinical Neurosurgery,2018,15(03):213.
[7]李国夫,张磊,程莹莹,等.术前头部DTI结合术中超声引导下导丝定位在功能区深部脑肿瘤手术的应用[J].临床神经外科杂志,2018,15(06):436.[doi:10.3969/j.issn.1672-7770.2018.06.009]
 LI Guo-fu,ZHANG Lei,CHENG Ying-ying,et al.Clinical value of preoperative DTI combined with ultrasound-guide guide wire in operation of deep seated brain tumors in functional area[J].Journal of Clinical Neurosurgery,2018,15(03):436.[doi:10.3969/j.issn.1672-7770.2018.06.009]
[8]任志伟,李建宇,赵倬翎,等.基于纤维束示踪技术的丘脑Vim核可视化定位方法研究[J].临床神经外科杂志,2019,16(4):335.[doi:10.3969/j.issn.1672-7770.2019.04.012]
 REN Zhi-wei,LI Jian-yu,ZHAO Zhuo-ling,et al.A novel method exploration of tractography-based ventral intermediate nucleus visualized targeting[J].Journal of Clinical Neurosurgery,2019,16(03):335.[doi:10.3969/j.issn.1672-7770.2019.04.012]

备注/Memo

备注/Memo:
上海市浦东新区卫生系统优秀青年医学人才培养(PWRq2013-13);上海市浦东新区科委项目(PKJ2015Y25);上海市卫生局医学重点专科建设项目资助(ZK2012A31);上海市浦东新区卫生局重点学科群建设项目资助(PWZxkq201102)
更新日期/Last Update: 2016-06-15