Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage.
Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage.
复制标题
微创丘脑血肿引流术可改善丘脑出血的六个月预后
DOI：
10.11909/j.issn.1671-5411.2017.04.006
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Huang QB
中科院分区：
文献类型：
--
作者：
Liu WM;Zhang XG;Zhang ZL;Li G;Huang QB
目的探讨丘脑出血6个月临床预后的预测因素，评价微创丘脑血肿引流术（THD）是否能改善其预后。方法回顾性分析54例自发性丘脑出血患者的临床资料。收集临床数据，包括人口统计学、卒中危险因素、神经影像学变量、入院时的格拉斯哥昏迷评分（GCS）、手术策略和结局。在发病后6个月，使用改良的兰金量表评估临床结局。进行单因素分析和多因素logistic回归分析以确定不良结局的预测因素。结果保守治疗5例（9.3%），脑室外引流（EVD）20例（37.0%），THD 4例（7.4%），EVD联合THD 25例（46.3%）。在发病后6个月，21例（38.9%）患者获得了良好的结局，而33例（61.1%）患者的结局较差。在单变量分析中，6个月预后不良的预测因素为入院时GCS较低（P = 0.001）、血肿体积较大（P < 0.001）、中线移位（P = 0.035）、急性脑积水（P = 0.039）和无THD（P = 0.037）。根据多因素Logistic回归分析，预后不良的独立预测因素是无THD和较大的血肿体积。结论微创THD在几天内清除了大部分血肿，对血肿周围脑组织的损伤有限，改善了丘脑出血的6个月预后。因此，THD可广泛应用于丘脑出血患者的治疗。
Objective To explore predictors of the 6-month clinical outcome of thalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage (THD) could improve its prognosis. Methods A total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score (GCS) on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome. Results Conservative treatment was performed for five patients (9.3%), external ventricular drainage (EVD) for 20 patients (37.0%), THD for four patients (7.4%), and EVD combined with THD for 25 patients (46.3%). At six months after onset, 21 (38.9%) patients achieved a favorable outcome, while 33 (61.1%) had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admission (P = 0.001), larger hematoma volume (P < 0.001), midline shift (P = 0.035), acute hydrocephalus (P = 0.039), and no THD (P = 0.037). The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume. Conclusions Minimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.