摘要
目的观察3D打印辅助定位下血肿穿刺引流术治疗高血压脑出血的疗效,探讨影响患者术后脑功能障碍的因素。方法采用回顾性病例对照研究的方法选择2020年1月—2022年9月岳池县人民医院收治的行3D打印辅助定位下血肿穿刺引流术治疗的168例高血压脑出血患者作为观察组,另选同期于岳池县人民医院行CT定位下血肿穿刺引流术治疗的125例高血压脑出血患者作为对照组,比较两组患者的临床疗效;根据术后脑功能障碍发生情况将观察组患者分为脑功能正常组(n=121)和脑功能障碍组(n=47),比较两组患者的年龄、术前脑疝、出血量、呼吸机辅助通气、术后格拉斯哥昏迷评分(GCS)、术后并发症等临床资料,多因素Logistic回归分析影响观察组患者术后脑功能障碍的因素,构建列线图模型并评价其预测效能。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验。结果观察组患者引流管位于血肿内比例、术后3 d和术后7 d的血肿清除率、治疗总有效率、术后1周GCS分别为88.69%(149/168)、54.17%(91/168)、96.43%(162/168)、92.86%(156/168)、(10.72±3.45)分,对照组分别为75.20%(94/125)、36.80%(46/125)、81.60%(102/125)、76.80%(96/125)、(9.08±3.22)分,两组相比差异具有统计学意义(P<0.05);多因素分析显示,高龄(OR=1.983,95%CI:1.169~2.732,P=0.017)、术前脑疝(OR=1.532,95%CI:1.113~2.139,P=0.029)、出血量≥50 mL(OR=2.538,95%CI:1.802~3.347,P=0.003)、术后GCS为3~5分(OR=2.874,95%CI:2.265~3.449,P<0.001)、术后低氧血症(OR=2.251,95%CI:1.673~2.842,P=0.010)、术后慢性脑积水(OR=1.642,95%CI:1.214~2.021,P=0.022)是影响患者术后脑功能障碍的危险因素,呼吸机辅助通气(OR=0.656,95%CI:0.132~0.828,P=0.038)是保护因素;内部验证结果显示,模型的区分度较高,准确性和有效性较好。结论血肿穿刺引流术中应用3D打印辅助定位能够改善穿刺情况,提高高血压脑出血患者的血肿清除率和临床疗效,高龄、术前脑疝、出血量等与患者术后脑功能障碍有关,临床应密切关注存在术后脑功能障碍风险指标的患者。
Objective To observe the efficacy of 3D printing-assisted hematoma puncture and drainage in the treatment of hypertensive intracerebral hemorrhage and to explore the factors affecting postoperative brain dysfunction.Methods A retrospective Case-control study was conducted to select 168 hypertensive intracerebral hemorrhage patients who were treated with 3D printing assisted hematoma puncture and drainage in the People′s Hospital of Yuechi County from January 2020 to September 2022 as the observation group,and 125 hypertensive intracerebral hemorrhage patients who were treated with CT guided hematoma puncture and drainage in the People′s Hospital of Yuechi County at the same time as the control group.The clinical efficacy of the two groups of patients was compared.According to the occurrence of postoperative brain dysfunction,the patients in the observation group were divided into normal brain function group(n=121)and brain dysfunction group(n=47).The clinical data of age,preoperative cerebral hernia,blood loss,ventilator-assisted ventilation,postoperative Glasgow coma index score(GCS)and postoperative complications were compared between the two groups.Multivariate Logistic regression was used to analyze the factors affecting postoperative brain dysfunction in the observation group,and a line chart model was constructed and its predictive efficiency was evaluated.The measurement data of normal distribution is expressed as mean±standard deviation(x±s),and independent sample t-test is used for inter group comparison.Chi-square test was used for comparison between count data groups.Results The proportion of the drainage tube in the hematoma,hematoma clearance rate at 3 and 7 days after surgery,total effective rate of treatment,and GCS score at 1 week after surgery in the observation group were 88.69%(149/168),54.17%(91/168),96.43%(162/168),92.86%(156/168),and 10.72±3.45,respectively,the control group was 75.20%(94/125),36.80%(46/125),81.60%(102/125),76.80%(96/125),and 9.08±3.22,respectively,the difference between the two groups was statistically significant(P<0.05).Advanced age(OR=1.983,95%CI:1.169-2.732,P=0.017),preoperative cerebral hernia(OR=1.532,95%CI:1.113-2.139,P=0.029),bleeding volume≥50 mL(OR=2.538,95%CI:1.802-3.347,P=0.003),postoperative GCS score 3-5(OR=2.874,95%CI:2.265-3.449,P<0.001),postoperative hypoxemia(OR=2.251,95%CI:1.673-2.842,P=0.010)and postoperative chronic hydrocephalus(OR=1.642,95%CI:1.214-2.021,P=0.022)were risk factors for postoperative brain dysfunction,while ventilator-assisted ventilation(OR=0.656,95%CI:0.132-0.828,P=0.038)was protective factors.The internal verification of the line chart model by Bootstrap resampling method shows that the model has high differentiation,accuracy and validity.Conclusion The application of 3D printing-assisted localization in hematoma puncture and drainage can improve the puncture condition and the hematoma clearance rate and clinical effect of patients with hypertensive intracerebral hemorrhage.Advanced age,preoperative cerebral hernia and bleeding volume are related to postoperative brain dysfunction.Clinical attention should be paid to patients with risk indicators of postoperative brain dysfunction.
作者
苑文成
蒋汉刚
付煜
田华
何佳
吕光淘
Yuan Wencheng;Jiang Hangang;Fu Yu;Tian Hua;He Jia;Lyu Guangtao(Department of Neurosurgery,the People′s Hospital of Yuechi County,Guang′an 638300,China;Department of Neurosurgery,Guang′an People′s Hospital,Guang′an 638300,China)
出处
《国际外科学杂志》
2023年第8期537-544,F0004,共9页
International Journal of Surgery
关键词
颅内出血
高血压性
血肿
引流术
3D打印辅助定位
脑功能障碍
临床疗效
Intracranial hemorrhage,hypertensive
Hematoma
Drainage
3D printing aided positioning
Brain dysfunction
Clinical curative effect
