探讨枕下后正中-膜髓帆入路手术治疗高血压性脑桥出血患者的临床疗效。

回顾性分析2023年1月至9月厦门大学附属中山医院神经外科采用枕下后正中-膜髓帆入路手术治疗的8例原发性高血压性脑桥出血的临床资料。采用单因素分析确定患者年龄、性别、入院时收缩压、入院时舒张压、术前格拉斯哥昏迷量表（GCS）评分、术前是否气管插管、发病至手术时间、血肿体积、术后残余量、血肿清除率、术后是否颅内感染与术后6个月病死率的关系。术后6个月，采用格拉斯哥结局量表（GOS）评估预后。采用SPSS 26.0软件进行统计分析。计量资料的组间比较根据数据分布特征选用t检验或Mann-Whitney U检验；计数资料采用Fisher精确概率法检验。

在8例患者中，术后6个月未死亡5例、死亡3例。未死亡组和死亡组患者的平均年龄、性别、入院时收缩压、入院时舒张压、术前气管插管、发病至手术时间、颅内感染上比较，差异均无统计学意义（P均>0.05）。未死亡和死亡组患者在术前GCS评分[5.0（5.0，5.0）分 vs 4.0（3.5，4.0）分]、术后残余量[0.2（0.2，0.4）mL vs 1.4（1.4，1.5）mL]、血肿体积[（6.30±1.04）mL vs（9.47±1.50）mL]、血肿清除率[（95.37±3.13）% vs （84.21±3.00）%]上比较，差异均有统计学意义（Z=2.037、2.263，t=3.563、4.945；P=0.042、0.024、0.012、0.003）。GOS Ⅰ级3例、Ⅱ级1例、Ⅲ级3例、Ⅳ级1例。

膜髓帆入路脑桥血肿清除术有助于早期减压并提高血肿清除率。术前GCS评分、血肿体积、术后残余量、血肿清除率是术后6个月死亡的相关因素。

To investigate the clinical efficacy of the suboccipital posterior median-telovelar approach for hypertensive pontine hemorrhage.

The clinical data of 8 patients with primary hypertensive pontine hemorrhage, who were treated by the suboccipital posterior media-telovelar approach from January 2023 to September 2023 in the Department of Neurosurgery at Zhongshan Hospital Xiamen University, were retrospectively analyzed. Univariate analysis assessed factors related to 6-month mortality, including age, gender, admission systolic blood pressure, admission diastolic blood pressure, preoperative Glasgow coma score (GCS), endotracheal intubation upon admission, time from onset to operation, hemorrhage volume, postoperative residual and hematoma clearance rate, and postoperative intracranial infection. Outcomes were assessed by the 6-month Glasgow outcome scale (GOS). Statistical analysis was performed using SPSS 26.0 software. Continuous variables were compared using the t-test or Mann-Whitney U test based on distribution characteristics; categorical variables were analyzed with Fisher's exact test.

Of the 8 patients included, 5 survived and 3 died within 6 months. No significant differences were observed between the nonsurvival group and the survival group in mean age, gender, admission systolic blood pressure, admission diastolic blood pressure, preoperative tracheal intubation, time from onset to operation, and intracranial infection (all P>0.05). Significant differences were observed between the nonsurvival and survival groups regarding preoperative GCS score [5.0 (5.0, 5.0) scores vs 4.0 (3.5, 4.0) scores, Z=2.037, P=0.042], postoperative residual [0.2 (0.2, 0.4) mL vs 1.4 (1.4, 1.5) mL, Z=2.263, P=0.024], hematoma volume [(6.30±1.04) mL vs (9.47±1.50) mL, t=3.563, P=0.012], and hematoma clearance [(95.37±3.13)% vs (84.21±3.00)%, t=4.945, P=0.003]. GOS scores at 6 months were distributed as follows: Grade Ⅰ in 3 patients, Grade Ⅱ in 1, Grade Ⅲ in 3, and Grade Ⅳ in 1.

The telovelar approach facilitates early decompression and improves hematoma evacuation in pontine hemorrhage. Preoperative GCS score, bleeding volume, postoperative residual, and hematoma clearance were significantly associated with 6-month mortality.