颅脑钻孔引流术与开颅治疗高血压脑出血对神经功能及预后的影响  

Observation of neurological function and prognosis of craniocerebral trepanation and drainage versus craniotomy in the treatment of hypertensive cerebral hemorrhage

作　　者：杜福宏[1] 宋良鹏 郑德伟[1] 盛毅[1] 李洪朋 孙西周 Du Fuhong Song Liangpeng Zheng Dewei Sheng Yi Li Hongpeng Sun Xizhou(Department of Neurosurgery, the Traditional Chinese Medicine Hospital of Rizhao City ,Rizhao 276800, Chin)

机构地区：[1]山东日照市中医医院神经外科,日照276800

出　　处：《中国实用神经疾病杂志》2016年第18期8-10,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的观察颅脑钻孔引流术与开颅治疗高血压脑出血对神经功能及预后的影响。方法选取我院2010-06—2011-06 86例高血压脑出血患者为研究对象,抽签随机分为A组与B组,每组43例。A组给予颅脑钻孔引流术治疗,B组给予开颅术治疗,比较2组手术时间、术中出血量、首次血肿清除率及血肿消失时间,神经功能缺损评分,并发症发生率及预后。结果 A组手术时间(37.03±9.86)min短于B组(116.12±8.73)min,首次血肿清除率(40.23±8.47)%低于B组(72.54±9.16)%,血肿消失时间(4.96±1.30)d长于B组(3.61±1.25)d,差异有统计学意义(P<0.05)。2组治疗前神经功能缺损评分比较差异无统计学意义(P>0.05);治疗后A组神经功能缺损评分(12.24±3.17)分低于B组(21.68±3.52)分,差异有统计学意义(P<0.05)。A组肺部感染率2.33%低于B组16.28%,术后再出血率18.60%高于B组4.65%,差异有统计学意义(P<0.05)。A组预后不良率25.58%低于B组46.51%,差异有统计学意义(P<0.05)。结论颅脑钻孔引流术手术时间短,创伤小,操作简单,可促进神经功能恢复,改善预后,但血肿消失时间长、首次血肿清除率低及术后再出血率高,可根据患者综合情况选择合理的手术方式。Objective To observe neurological function and prognosis of craniocerebral trepanation and drainage versus craniotomy in the treatment of hypertensive cerebral hemorrhage（HCH）.Methods Eighty-six patients with HCH in our hos-pital from June 2010 to June 201 1 were selected in our study,who were divided into group A and group B（43 cases in each group）according to draw method.The group A underwent craniocerebral trepanation and drainage while the group B received craniotomy.Then operation time,amount of intraoperative blood loss,clearance rate of hematoma for the first time,time of he-matoma disappearing,neurological function defect score,complication rate and prognosis in the two groups were compared.Re-sults Operation time of the group A was （37.03 ± 9.86 ）minutes,significantly shorter than（1 1 6.12 ± 8.73 ）minutes in the group B.And the group A showed lower hematoma clearance rate（40.23±8.47%）than group B（72.54±9.1 6%）,time of he-matoma disappearing（4.96±1.30 d）in the group A was significantly longer than that in the group B（3.61±1.25 d）（All P 〈0.05）.Before the treatment there was no significant difference in neurological function defect score between the two groups （P 〉0.05）,but after treatment,which were（12.24±3.1 7）scores in the group A,significantly lower than（21.68±3.52）scores in the group B （P 〈 0.05 ）.The group A had the pulmonary infection rate of 2.33%,which was significantly lower than 1 6.28% in the group B;Similarly,group A showed higher postoperative re-bleeding rate（18.60%）than the group B（4.65%） （P 〈0.05 ）.Poor prognosis rate of the group A（25.58%）was significantly lower than that in the group B（46.5 1%）（P 〈0.05）.Conclusion Compared with craniotomy,craniocerebral trepanation and drainage show shorter operation time,better neurological functional recovery and better prognosis with smaller trauma and easier feasibility,but which may have longer time of hematoma disappearing,lower hematoma clearance rate for

关 键 词：颅脑钻孔引流术 开颅术 高血压脑出血 神经功能 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]