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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 154 -159. doi: 10.3877/cma.j.issn.2095-123X.2024.03.005

临床研究

神经导航引导下治疗基底节高血压脑出血的短期疗效预测
景方坤1, 周建波1, 王全才1, 黄海韬1, 李岩峰1,†(), 徐杨熙1   
  1. 1. 110000　沈阳，辽宁省人民医院神经外科
  • 收稿日期:2023-10-27 出版日期:2024-06-15
  • 通信作者: 李岩峰

Short-term efficacy prediction of neuronavigation-guided treatment of basal ganglia hypertensive intracerebral hemorrhage

Fangkun Jing1, Jianbo Zhou1, Quancai Wang1, Haitao Huang1, Yanfeng Li1,†(), Yangxi Xu1   

  1. 1. Department of Neurosurgery, Liaoning Provincial People's Hospital, Shenyang 110000, China
  • Received:2023-10-27 Published:2024-06-15
  • Corresponding author: Yanfeng Li
  • Supported by:
    Natural Science Foundation of Liaoning Province(2022-MS-074)
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景方坤, 周建波, 王全才, 黄海韬, 李岩峰, 徐杨熙. 神经导航引导下治疗基底节高血压脑出血的短期疗效预测[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 154-159.

Fangkun Jing, Jianbo Zhou, Quancai Wang, Haitao Huang, Yanfeng Li, Yangxi Xu. Short-term efficacy prediction of neuronavigation-guided treatment of basal ganglia hypertensive intracerebral hemorrhage[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(03): 154-159.

目的

探讨神经导航引导下治疗基底节高血压脑出血（HICH）的短期疗效及其预测。

方法

回顾性分析辽宁省人民医院神经外科自2020年1月至2021年6月收治的56例基底节HICH患者的临床资料。按照穿刺定位方法的不同分为2组，对照组（35例）应用传统定位法穿刺治疗，试验组（21例）应用神经导航辅助定位穿刺治疗。对比2组患者术后1周GCS评分、并发症和术后6个月Barthel指数（BI）评分；采用多因素Logistic回归分析研究基底节HICH不同术式的获益因素，通过R软件构建列线图风险预测模型并验证效果。

结果

2组患者术后并发症肺内感染、应激性溃疡发生率比较，差异无统计学意义（P>0.05）；试验组在术后1周GCS评分高于对照组，残余血量和住院天数低于对照组，手术时间长于对照组，治疗后6个月BI评分优于对照组，差异均有统计学意义（P<0.05）。多因素Logistic回归分析显示术后残余血量和住院时间为基底节HICH患者术后疗效的独立影响因素，据此构建列线图模型，Bootstrap法内部验证显示Calibrate曲线图显示模型校准度良好。

结论

神经导航辅助下治疗基底节HICH手术治疗可减少术后脑内残余血量，降低患者住院天数，促进术后远期生活自理能力的恢复，为促进脑出血患者康复和尽早回归社会提供新的治疗方案。

关键词: 高血压脑出血, 基底节, 神经导航, 手术治疗, 列线图
Objective

To explore and predict the short-term efficacy of neuronavigation-guided treatment for basal ganglia hypertensive intracerebral hemorrhage (HICH).

Methods

A retrospective analysis was conducted on the clinical data of 56 patients with basal ganglia HICH admitted to Neurosurgery Department of Liaoning Provincial People's Hospital from January 2020 to June 2021. According to different puncture positioning methods, they were divided into two groups. The control group (35 cases) received traditional localization puncture treatment, while the experimental group (21 cases) received neuronavigation-guided localization puncture treatment. The GCS score at 1 week after surgery, complications and the Barthel index (BI) score at 6 months after surgery between the two groups were compared. Multivariate Logistic regression were used to analyze the benefit factors of different surgical methods for basal ganglia HICH, and the R software was used to construct a nomogram risk prediction model and verify the effect.

Results

There was no statistical difference in intra-pulmonary infections, and the incidence of stress ulcers between the two groups (P>0.05). The experimental group had a higher GCS score at 1 week after surgery than the control group, lower residual blood volume and hospitalization days than the control group, the longer surgical operation time than the control group, and the BI score at 6 months after treatment was better than that of the control group, with statistical significances (P<0.05). Multivariate Logistic regression analysis showed that postoperative residual blood volume and hospitalization days were independent benefit factors. The internal verification of the Bootstrap method showed that the calibration curve showed that the model was well calibrated.

Conclusion

Surgical treatment of basal ganglia HICH assisted by neuronavigation can reduce postoperative intracerebral residual blood and hospitalization days, promote the recovery of long-term self-care ability after surgery, and provide a new therapeutic option for promoting the rehabilitation of cerebral hemorrhage patients and early return to society.

Key words: Hypertensive intracerebral hemorrhage, Basal ganglia, Neuronavigation, Surgical treatment, Nomogram
表1 2组患者的临床基线资料比较
Tab.1 Comparison of clinical baseline data between two groups
项目 对照组（n=35） 试验组（n=21） t/χ2值 P值
年龄（岁，Mean±SD） 71.11±6.62 72.10±7.09 0.522 0.604
性别[例（%）]     0.123 0.726
男 20（57.14） 13（61.90）    
女 15（42.86） 8（38.10）    
出血量（mL，Mean±SD） 38.57±8.81 36.00±2.36 1.011 0.317
吸烟史[例（%）] 30（85.71） 15（71.43） 1.697 0.193
饮酒史[例（%）] 23（65.71） 10（47.62） 1.776 0.183
糖尿病[例（%）] 12（34.29） 9（42.86） 0.411 0.521
心血管疾病[例（%）] 6（17.14） 5（23.81） 0.370 0.543
术前C-反应蛋白（mg/L，Mean±SD） 51.43±20.20 53.95±15.35 0.493 0.624
术前GCS评分（分，Mean±SD） 11.00±2.54 11.19±1.63 0.307 0.760
表2 2组患者的短期疗效比较
Tab.2 Comparison of short-term effects of the two groups
项目 对照组（n=35） 试验组（n=21） t/χ2值 P值
术后GCS评分（分，Mean±SD） 12.95±1.56 14.00±0.91 3.176 0.020
术后残余血量（mL，Mean±SD） 17.51±5.48 14.19±4.64 2.321 0.020
手术时间（min，Mean±SD） 41.29±3.08 49.51±2.68 3.708 0.042
住院天数（d，Mean±SD） 25.79±2.22 20.22±0.96 3.723 0.011
住院费用（万元，Mean±SD） 4.43±1.34 4.68±0.95 0.726 0.471
术后并发症[例（%）]        
肺内感染 18（51.43） 12（57.14） 0.172 0.678
应激性溃疡 8（22.86） 4（19.05） 0.113 0.737
Barthel指数评分>60分[例（%）] 12（36.36） 13（65.00） 4.098 0.043
死亡[例（%）] 2（5.714） 1（4.762） 0.037 >0.999
表3 基底节HICH患者手术疗效因素的多因素Logistic回归分析
Tab.3 Multivariate stepwise Logistic regression of factors influencing surgery for patients with basal ganglia intracerebral hemorrhage
项目 偏回归系数 标准误 Z值 Wald值 P值 OR（95%CI）
常数 -12.510 6.211 2.447 4.057 0.014 -
术后GCS评分 0.317 0.301 1.113 1.109 0.266 1.397（0.795~2.668）
术后残余血量 0.169 0.085 2.254 3.953 0.024 1.212（1.042~1.466）
手术时间 0.042 0.034 1.613 1.526 0.107 1.057（0.992~1.139）
住院天数 0.269 0.079 2.513 11.594 0.012 1.219（1.064~1.462）
Barthel指数评分>60分 -0.132 0.789 1.662 0.028 0.097 3.713（0.862~20.310）
图1 列线图预测基底节HICH术后风险及其预测性能A：估计神经导航辅助下术后获益率的列线图；B：列线图在估计队列研究中应用神经导航辅助治疗脑出血方面的预测性能的有效性
Fig.1 Nomogram for predicting postoperative risk of basal ganglia HCIH and its predictive performance
[1]
Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review[J]. Lancet Neurol, 2009, 8(4): 355-369. DOI: 10.1016/s1474-4422(09)70025-0.
[2]
Ru X, Wang W, Sun H, et al. Geographicaldifference, rural-urban transition and trend in stroke prevalence in China: findings from a national epidemiological survey of stroke in China[J]. Sci Rep, 2019, 9(1): 17330. DOI: 10.1038/s41598-019-53848-1.
[3]
Wang A, Sun Z, Zhang W, et al. Efficacy and safety of endoscopic surgery versus craniotomy for hypertensive putamen hemorrhage[J]. J Craniofac Surg, 2024, 35(4): 1181-1185. DOI: 10.1097/scs.0000000000010105.
[4]
Katsuki M, Narita N, Sato K, et al. Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate-comparison between trans-forehead and along-the-long-axis approaches[J]. Surg Neurol Int, 2021, 12: 41. DOI: 10.25259/sni_887_2020.
[5]
Jiang L, Tian J, Guo C, et al. Comparison of the efficacy of neuronavigation-assisted intracerebral hematoma puncture and drainage with neuroendoscopic hematoma removal in treatment of hypertensive cerebral hemorrhage[J]. BMC Surg, 2024, 24(1): 86. DOI: 10.1186/s12893-024-02378-3.
[6]
徐昌林,程浩,刘从国,等. Rosa定位钻孔血肿清除术与经验性定位颅骨钻孔血肿清除术治疗自发性脑出血的疗效对比分析[J].中华神经创伤外科电子杂志, 2023, 9(2): 97-101. DOI: 10.3877/cma.j.issn.2095-9141.2023.02.006.
[7]
Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage[J]. Stroke Vasc Neurol, 2017, 2(1): 21-29. DOI: 10.1136/svn-2016-000047.
[8]
Amarenco P. Transient ischemic attack[J]. N Engl J Med, 2020, 382(20): 1933-1941. DOI: 10.1056/NEJMcp1908837.
[9]
Xue M, Yong VW. Neuroinflammation in intracerebral haemorrhage: immunotherapies with potential for translation[J]. Lancet Neurol, 2020, 19(12): 1023-1032. DOI: 10.1016/s1474-4422(20)30364-1.
[10]
Wei LJ, Lin C, Xue XS, et al. The effect of hematoma puncture drainage before decompressive craniectomy on the prognosis of hypertensive intracerebral hemorrhage with cerebral hernia at a high altitude[J]. Chin J Traumatol, 2021, 24(6): 328-332. DOI: 10.1016/j.cjtee.2021.08.006.
[11]
Mendelow AD, Gregson BA, Rowan EN, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): A randomised trial[J]. Lancet, 2013, 382(9890): 397-408. DOI: 10.1016/s0140-6736(13)60986-1.
[12]
de Oliveira Manoel AL. Surgery for spontaneous intracerebral hemorrhage[J]. Crit Care, 2020, 24(1): 45. DOI: 10.1186/s13054-020-2749-2.
[13]
Li Y, Yang R, Li Z, et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy[J]. World Neurosurg, 2017, 105: 332-340. DOI: 10.1016/j.wneu.2017.05.134.
[14]
Leksell L, Lindquist C, Adler JR, et al. A new fixation device for the leksell stereotaxic system. Technical note[J]. J Neurosurg, 1987, 66(4): 626-629. DOI: 10.3171/jns.1987.66.4.0626.
[15]
Spiegel EA, Wycis HT, et al. Stereoencephalotomy[J]. Proc Soc Exp Biol Med, 1948, 69(1): 175-177. DOI: 10.3181/00379727-69-16658p.
[16]
Atteya MME. Frameless stereotaxy: it is all about precision[J]. Childs Nerv Syst, 2020, 36(1): 179-187. DOI: 10.1007/s00381-019-04390-y.
[17]
Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: An update on diagnosis and treatment[J]. Expert Rev Neurother, 2019, 19(7): 679-694. DOI: 10.1080/14737175.2019.1623671.
[18]
Lian M, Li X, Wang Y, et al. Comparison of two minimally invasive surgical approaches for hypertensive intracerebral hemorrhage: A study based on postoperative intracranial pressure parameters[J]. BMC Surg, 2024, 24(1): 10. DOI: 10.1186/s12893-023-02306-x.
[19]
钱晟,杨珉,许先平,等.导航辅助神经内镜硬通道微创治疗基底节区高血压脑出血的疗效及安全性分析[J].川北医学院学报, 2023, 38(3): 323-327. DOI: 10.3969/j.issn.1005-3697.2023.03.008.
[20]
姚瀚勋,夏学巍,肖晶,等.导航辅助神经内镜硬通道技术治疗基底节区高血压脑出血患者的临床疗效[J].重庆医学, 2018, 47(8): 1055-1057. DOI: 10.3969/j.issn.1671-8348.2018.08.014.
[21]
黄毅,黄常坚,黄建荣. 3D Slicer软件联合手机导航辅助神经内镜手术治疗基底节区高血压脑出血患者的临床效果[J].广西医学, 2022, 44(12): 1425-1428. DOI: 10.11675/j.issn.0253-4304.2022.12.24.
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