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目的微创治疗高血压性脑出血对皮质脊髓束及预后的影响。方法将62例高血压性脑出血患者分为观察组31例和对照组31例,对照组给予常规药物治疗,观察组行立体定向下钻孔引流术,分别于入院时、治疗3个月后进行磁共振弥散张量成像(DTI)检查,对两组患者神经功能改善情况进行评定,计算患侧/对侧的部分各向异性(FA)值。结果两组皮质脊髓束4级患者治疗3个月后FA值比较,差异无统计学意义(t=1.35,P>0.05),但观察组皮质脊髓束1~3级患者治疗3个月后FA值高于对照组,差异有统计学意义(t=2.05,P<0.05)。两组入院时美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(t=1.01,P>0.05),观察组治疗3个月后NIHSS评分低于对照组,差异有统计学意义(t=12.24,P<0.05)。结论微创手术治疗高血压性脑出血的临床疗效较保守治疗更有优势,尤其是皮质脊髓束1~3级患者早期采取微创手术治疗的预后较好。
Objective To observe the effect of minimally invasive treatment of hypertensive cerebral hemorrhage on corticospinal tract and prognosis. Methods Sixty-two patients with hypertensive intracerebral hemorrhage were divided into observation group (31 cases) and control group (31 cases). The control group was given conventional drug therapy. The observation group underwent stereotactic drilling and drainage. At the time of admission and 3 months after treatment Magnetic resonance diffusion tensor imaging (DTI) was performed to evaluate the improvement of neurological function in both groups, and the partial anisotropy (FA) value of the affected side / contralateral side was calculated. Results There was no significant difference in FA between the two groups after 4 months of treatment (t = 1.35, P> 0.05). However, in the observation group, patients with grade 1 to 3 corticospinal tract disease were treated with FA for 3 months Value higher than the control group, the difference was statistically significant (t = 2.05, P <0.05). There was no significant difference in the NIHSS score between the two groups (t = 1.01, P> 0.05). NIHSS score in the observation group was lower than that in the control group after 3 months of treatment Significance (t = 12.24, P <0.05). Conclusions The minimally invasive surgical treatment of hypertensive intracerebral hemorrhage has more advantages than conservative treatment. Especially, patients with grade 1 ~ 3 of corticospinal tract have a better prognosis in the early stage of minimally invasive surgery.