Đánh giá đặc điểm lâm sàng kết quả của phương pháp mở sọ lấy máu tụ ở bệnh nhân đột quỵ chảy máu não trên lều

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Hoài Lân Đặng, Thị Tuyết Đỗ, Thị Ngọc Khanh Thạch, Thị Thu Hương Xuân

Ngôn ngữ: vie

Ký hiệu phân loại: 362.19681 Physical illness

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 228-237

Bộ sưu tập: Metadata

ID: 500566

Thêm vào giỏ

Chỉ định của phẫu thuật cho những bệnh nhân (BN) đột quỵ chảy máu não (ĐQ CMN) còn chưa rõ ràng. Mục đích của nghiên cứu là đánh giá đặc điểm lâm sàng và kết quả của phương pháp mở sọ lấy máu ở những BN ĐQCMN trên lều. Đối tượng và phương pháp: 55 BN ĐQCMN trên lều được điều trị bằng phương pháp mở sọ lấy máu tụ từ 12/2016 đến 4/2020 tại Khoa Đột quỵ, BVTWQĐ 108. Các đặc điểm lâm sàng của BN bao gồm tuổi, giới, độ nặng của đột quỵ (thang điểm của Đột quỵ - NIHSS)), hình ảnh CTscan sọ não (hình ảnh thoát vị não, vị trí và kích thước ổ máu tụ, đè đẩy đường giữa), thời gian từ khi khởi phát đến khi phẫu thuật, đặc điểm phẫu thuật và thời gian thở máy, tỷ lệ tử vong và mức độ khuyết tật của BN theo thang điểm Rankin sửa đổi (mRS) tại thời điểm 6 tháng sau đột quỵ. Kết quả: 55 BN (81,8% nam giới, tuổi trung bình 55 ± 11) được điều trị bằng phương pháp mở sọ lấy máu tụ. Điểm NIHSS trung bình là 26 (9-32)
CMN vùng nhân xám 69,1% BN
CMN thùy 30,9% BN. Mức độ đè đẩy đường giữa trung bình là 10,9 mm (4-20 mm). 23 BN có giãn não thất trước phẫu thuật, 14 BN có giãn não thất sau phẫu thuật. Sau phẫu thuật, không có BN nào có biến chứng viêm màng não. 4 BN phải đặt dẫn lưu não thất-ổ bụng. Điểm mRS của BN tại thời điểm ra viện là 5 (4-6). Sau 6 tháng, 17 (30,9%) BN có kết quả tốt (mRS 0- 3). Tỷ lệ tử vong là 14 (25,5%) BN. Khi so sánh giữa nhóm có kết quả hồi phục tốt và xấu, nhóm có kết quả tốt có điểm Glasgow cao hơn (trung bình 9.5 [SD=2.5] so với 8.0 [SD=1.9]
p=0.013). Những BN có kết cục xấu có tuổi trung bình cao hơn (trung bình 57.2 [SD=10.4] với 49.7 [SD=10.7]
p=0.017) và thể tích khối máu tụ lớn hơn (trung bình 95.8
[SD=32] với 71.6
[SD=33.0]
p=0.018) so với nhóm có kết cục tốt. Kết luận: phẫu thuật mở sọ lấy máu tụ có hiệu quả đối với những bệnh nhân chảy máu não trên lều trẻ tuổi.There has been no clear indication for surgical procedures for patients with intracerebral hemorrhage (ICH). The aim of this study was to investigate the effectiveness of decompressive craniectomy with hematoma evacuation for treating patients with supratentorial ICH. Methods: All patients with supratentorial ICH treated with decompressive craniectomy (DC) and hematoma removal between December 2016 and April 2020 at Stroke center of the 108 Military Central Hospital, Vietnam were included in this study. Patient characteristics and clinical information were analyzed, including age, sex, stroke severity (e.g, National Institutes of Health Stroke Scale), computed tomography (CT) scan data (signs of herniation, side and size of hematoma, midline shift), the time interval between ictus and surgery (time to indication for surgery), surgical characteristics, and time of ventilation. Study outcomes were: case fatality and modified Rankin Scale (mRS) at six months following stroke. Results: There were 55 patients (82% males
mean, 55 years
SD 11) were treated by DC. Median NIHSS (National Institutes of Health Stroke Scale) score at admission was 26 (interquartile range [IQR] 9-32). Approximately two third of patients (69.1%) had hematoma being located within the basal ganglia, while 30.9% had lobar. The median midline shift was 10.9 mm (IQR 4-20 mm). Intraventricular extensions were observed in 23 patients on the pre-operative CT scan, and 14 patients on the post-operative CT scan. Complications after DC, meningitis was observed in none of all patients (0%). Four patients (7.3%) had undergone placement of a ventriculoperitoneal shunt (VPS) for hydrocephalus. At discharge, the median modified Rankin Scale (mRS) score was 5 (IQR 4-6). Six months after hemorrhage, 17 patients (30.9%) had favorable outcomes (mRS score 0-3) and the remaining had poor outcomes (mRS score 4-6). The mortality rate was 25.5% (n=14 patients). Compared to poor outcome group, those with favorable outcomes had significantly higher GCS score (mean, 9.5 [SD=2.5] vs 8.0 [SD=1.9]
p=0.013). By contrast, those who had poor outcomes were more likely to be older (mean 57.2 [SD=10.4] vs 49.7 [SD=10.7]
p=0.017) and had greater hematoma volume (mean 95.8
[SD=32] vs 71.6
[SD=33.0]
p=0.018). Conclusions: DC with hematoma evacuation could be useful for selected group of young patients with large hemispheric ICH.

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