中重型脑出血患者术后常规气管切开并行冬眠疗法的疗效分析  

Clinical Effect of Routine Tracheostomy and Hibernation Therapy after Craniotomy in Patients with Moderate or Severe Hypertensive Intracranial Hemorrhage

作　　者：章剑剑[1] 陈汉平[1] 翁睿光[1] 刘军[1] 叶晖[1] 

机构地区：[1]江汉大学附属第二医院神经外科,湖北省武汉市430050

出　　处：《中国全科医学》2009年第22期2063-2064,共2页Chinese General Practice

摘　　要：目的从多方面分析中重型脑出血患者术后行常规气管切开并行冬眠疗法的疗效。方法对我科2004年1月—2008年6月收治的69例中重型高血压脑出血开颅术后常规行气管切开并行冬眠疗法的患者进行回顾性研究,随机抽取同期93例中重型高血压脑出血患者作为对照组,从血压波动、再出血发生率及患者ADL分级3个方面分析此种治疗方法的疗效。结果研究组未采用降压药物治疗但血压波动范围小,对照组总体血压波动相对较大,两组比较差异有统计学意义(t=2.351,P<0.01);研究组再出血发生率(7%)低于对照组(18%),差异有统计学意义(χ2=4.109,P<0.05);ADL2～4级的患者在本研究中占了相当大的比例,研究组恢复相对良好的患者(ADL1～3级)明显多于对照组,差异有统计学意义(χ2=4.649,P<0.05)。结论开颅血肿清除加去骨瓣减压术是中重型高血压脑出血有效的治疗方法,而术后常规气管切开并行冬眠疗法能显著改善患者预后。Objective To analyze in various aspects the clinical effects of conventional tracheostomy and hibernation therapy after craniotomy in patients with moderate or severe hypertensive intracranial hemorrhage （HIH）. Methods A retrospective analysis was carried out on data of 69 moderate or severe HIH patients who received conventional tracheostomy and hiber- nation therapy following craniotomy in our department from January 2004 to June 2008. Ninety - three moderate or severe HIH patients in the same period were randomly chosen as control. Fluctuation of blood pressure （ BP）, rebleeding incidence and ADL grading were analyzed. Results In research group antihypertensive drug therapy was not used and BP fluctuated in a smaller scope, while in control BP in a larger, and the difference was significant （ t = 2. 351, P 〈 0. 01 ）. The rebleeding incidence of research group （7%） was significantly lower than that of control （ 18% ） （ χ^2 = 4. 109, P 〈 0. 05 ）. ADL grading II - IV patients accounted for a fairly large proportion in this study, and patients having relatively good prognoses （ grading I -Ⅲ） were significantly more in research group than in control （ χ^2 = 4. 649, P 〈 0. 05 ）. Conclusion Evacuation of intracranial hematomas with decompressive craniectomy is an effective treatment of moderate or severe HIH, but conventional tracheostomy and hi- bernation therapy can improve significantly patients＇ prognoses.

关 键 词：高血压 脑出血 血压波动 再出血 ADL分级 

分 类 号：R651.1[医药卫生—外科学]