不同手术方式治疗老年早期基底节区高血压脑出血患者疗效及预后随访  

Comparison of therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage in basal ganglia region in elderly patients and their prognostic factors analysis

作　　者：宋大勇[1] 赵军[1] 张宁[1] 许大远[1] 权哲[1] 李志强[1] 

机构地区：[1]上海交通大学附属第六人民医院南院神经外科,201499

出　　处：《中华老年医学杂志》2017年第7期742-745,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨不同手术方式治疗老年早期基底节区高血压脑出血（HICH）的疗效，以及对预后的影响。方法根据术式及是否行颅内压监测，将89例老年基底节区HICH患者随机分成4组。A组（21例）采用微创血肿外引流、B组（23例）采用小骨窗开颅血肿清除，c组（21例）、D组（24例）分别在A组、B组的基础上联合颅内压监测（ICP）。比较各组手术前后颅内压变化、术后并发症、预后情况。结果术后3d、7dC组、D组患者的颅内压较A组、B组下降（F=11．76，P〈0．05）；术后7d，C组、D组GCS评分较A组、B组升高，术后14、28d，C组GCS评分较A组、13组均明显升高，术后28d，C组GCS评分明显高于D组（F=4．72，19．24，22．26，均P〈0．05）；C组、D组甘露醇的使用剂量较A组、B组明显减少（F=18．87，P〈0．05）；C组并发症发生率为14．3％，低于B组47．8％（x2=7．04，P〈0．05）；C组、D组良好、轻残的比例（76．2％、75．0％）高于A组、B组（42．9％、39．1％）（x2=14．99，P〈0．05）。结论微创手术清除血肿治疗老年基底节HICH患者创伤小、并发症少，联合术后持续ICP有助于早期发现颅内压的改变，减少脱水药物的用量，改善患者预后。Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage （HICH）in basal ganglia region in elderly patients and on prognostic factors analysis. Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored. Group A（n=21） was given minimally invasive hematoma drainage, group B（n = 23）was given small bone window for removal of hematoma, group C （n = 21）and group D （n=24）was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively. The changes of intracranial pressure before and after operation, prognosis and post-operative complications were compared. Results The intracranial pressure was significantly decreased at 3rd day, 7th day after operation in group C and D as compared with those in group A and B at the same time points（F=11.76,P〈0.05） ,and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points（F=4.72,P〈0.05）. At 14th and 28th day after operation, the score of GCS was higher in group C than in group A and B（F= 19.24,P〈0.05） ,and higher in group C than in group D at 28th day after operation（F=22.26,P〈0.05）. The dosage of mannitol was significantly lower in group C and group D than in group A and group B（F= 18.87,P〈0.05）. The incidence rate of post operative complications was 14.3% in group C vs. 28.6% in group A（P〈0.05） and 20.8% in group D vs. 47.8% in group B（X2 =7.04,P〈C0.05）. The proportion of a good recovery and a light disability was significantly higher in group C and D（76.2% and 75.0%）than in group A and B（42.9% and 39. 1%）respectively（x2 = 14.99,all P〈0.05）. Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intr

关 键 词：高血压脑出血 基底节区 颅内压监测 微创血肿外引流 预后 

分 类 号：R651.12[医药卫生—外科学]