背景:手术干预在改善丘脑-内囊区中度脑出血的长期预后方面的有效性仍未被临床研究证实。因此,获取可靠的证据对于验证这些方法的有效性至关重要。
方法:符合条件的中度丘脑内囊区脑出血患者103例。使用1:1倾向得分匹配方法后的27对成功匹配,共有54名患者,进行了分析。比较立体定向手术组和保守治疗组患者的短期和长期治疗效果。采用logistic回归分析和模型比较分析2组患者的预后。
结果:本研究的主要结果是评估治疗6个月后的日常生活评分。基于本研究的分析,治疗6个月后,手术组的日常生活能力评分明显高于保守治疗组(P<0.001),差异有统计学意义。立体定向手术组3天血肿残留量明显低于保守治疗组,7天,发病后2周(P<0.001),且并发症发生率低于保守治疗组(P<0.05)。单因素logistic回归分析显示,手术组患者发生严重神经功能障碍的风险为(比值比-0.27,95%可信区间:0.08~0.86,P<0.05)。在多变量逻辑回归分析中,校正所有协变量后的比值比为0.29(95%置信区间:0.09-0.96,P<0.05).
结论:对于中度丘脑内囊区脑出血,与保守治疗相比,立体定向穿刺术具有住院时间短和并发症发生率低的优势。此外,在治疗6个月后的日常生活评估评分和神经功能恢复方面,它产生了更好的结局.
The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies.
One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the 2 groups of patients was analyzed by logistic regression analysis and model comparison.
The primary outcome of this study was to assess the assessment of daily living scores after 6 months of treatment. Based on the analysis of this study, the assessment of daily living of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P < 0.001), and the difference was statistically significant. The amount of residual hematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days, and 2 weeks after the onset of the disease (P < 0.001), and the complication rate was lower than the conservative treatment group (P < 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (odds ratio -0.27, 95% confidence interval: 0.08-0.86, P < 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% confidence interval: 0.09-0.96, P < 0.05) after adjusting for all covariates.
For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.