钻孔引流术联合开颅血肿清除术治疗急危重症高血压性脑出血  

Treatment of acute severe hypertensive cerebral hemorrhage by burr hole drainage combined with craniotomy evacuation of hematomas

作　　者：田军[1] 屈浙 姜博[1] 宋春旺[1] 左书浩[1] 

机构地区：[1]石家庄市第一医院神经外科,050011

出　　处：《中国临床神经外科杂志》2017年第5期305-307,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨钻孔引流术联合开颅血肿清除术治疗急危重症高血压性脑出血的临床效果。方法 2015年1月至2016年10月收治急危重症急危重症高血压性脑出血100例,按治疗方法分为观察组(60例)和对照组(40例)。对照组采用开颅血肿清除术治疗;观察组采用钻孔引流术联合开颅血肿清除术治疗。结果观察组术后发生肺部感染15例(25.0%)、再出血7例(11.7%)、应激性溃疡6例(10%);对照组术后发生肺部感染24例(60.0%)、再出血11例(27.5%)、应激性溃疡10例(25.0%);观察组术后肺部感染、再出血、应激性溃疡等发生率均明显低于对照组(P<0.05)。观察组术前GCS评分为(6.6±2.2)分,对照组术前GCS评分为(6.9±1.8)分;两组无统计学差异(P>0.05)。术后3个月,观察组和对照组GCS评分分别为(11.4±3.3)分、(9.4±2.7)分;两组术后3个月GCS评分均明显高于术前(P<0.05),而且观察组明显高于对照组(P<0.05)。术后6个月,观察组GOS评分5分13例,4分11例,3分10例,2分4例,1分2例;对照组GOS评分5分33例,4分15例,3分8例,2分3例,1分1例;观察组GOS评分明显优于对照组(P<0.05)。结论采用钻孔引流术联合开颅血肿清除术治疗急危重症急危重症高血压性脑出血,能降低并发症发生风险,改善病人意识状态,促进病人神经功能恢复,提高治疗效果。Objective To explore the clinical effect of burr hole drainage combined with hematoma evacuation through craniotomy with small bone flap on acute severe hypertensive cerebral hemorrhage （HCH）. Methods Of 100 hundred patients with acute severe HCH undergoing operation from January 2015 to October 2016, 40 were treated with hematoma evacuation through craniotomy with small bone flap （control group） and 60 were treated by burr hole drainage combined with hematoma evacuation through craniotomy with small bone flap （observation group）. Results The rates of postoperative pulmonary infection （25.0%, 15/60）, rebleeding （11.7%, 7/60） and stress ulcer （10.0%, 6/60） were significantly lower in the observation group than those [60.0% （24/40）, 27.5% （11/40）, 25.0% （10/40）, respectively] in the control group （P〈0.05）. There was no signifiant difference in the preoperative GCS score between the observation group [（6.6±2.2） points] and the control group [（6.9±1.8） points; P〉0.05]. The GCS score in the observation group [（11.4±3.3） points] was significantly higher than that [（9.4±2.7） points] the control group 3 months after operation （P〈0.05）. The GOS score in the observation group was significantly better than that in the control group 6 months after the operation （P〈0.05）. Conclusion The use of burr hole drainage combined with hematoma evacuation through craniotomy with small bone flap in the treatment of acute severe HCH can reduce the rate of postoperative complications, improve the state of consciousness and improve the progonosis.

关 键 词：高血压性脑出血 急危重症 钻孔引流术 开颅血肿清除术 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]