钻孔及锥孔两种入颅方式在高血压脑出血置管引流术中的应用  

Application of boring hole and tapering hole cranial approaches in catheter drainage in hypertensive cerebral hemorrhage

作　　者：刘帅[1] 王晓峰[1] 唐宗椿[1] 张宏兵[1] 王怡 LIU Shuai;WANG Xiaofeng;TANG Zongchun;et al(Depatment of Neurosurgery, the Third Hospital of PLA, Baoji 721004,China)

机构地区：[1]解放军第三医院神经外科,陕西宝鸡721004

出　　处：《西北国防医学杂志》2017年第11期736-739,共4页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的:分析比较钻孔及锥孔两种入颅方式在高血压脑出血置管引流术中的应用效果。方法:选择2012~2016年我院收治的需行置管引流术的高血压脑出血患者312例,入院后采取随机数字表法分为钻孔组和锥孔组,每组各156例。钻孔组采用钻孔方式充分暴露大脑皮层后行脑内穿刺,锥孔组采用穿刺点头皮外直接穿刺,后续治疗理念、原则均相同,并对两组患者的治疗效果进行对比。结果:两组患者脑内穿刺道出血情况无明显差异。锥孔组术后1月内病死率(12.82%)稍高于钻孔组(7.69%),但无统计学意义。钻孔组术中出血量较锥孔组明显多,锥孔组手术时间较钻孔组明显短,差异具有统计学意义(P<0.05)。锥孔组脑皮层表面出血、硬膜下血肿、硬膜外血肿的发生率较钻孔组明显高,差异具有统计学意义(P<0.05)。两组患者非计划拔管、颅内感染、穿刺点脑脊液漏、引流管移位发生率比较,差异无统计学意义。结论:钻孔及锥孔两种入颅方式,在临床应用中各有利弊,应根据患者实际情况,合理、个性化地进行选择,但钻孔方式能较大可能地避免脑皮层、硬膜下、硬膜外出血,在可耐受人群中,建议推广使用。Objective：To compare and analyze the effect of boring hole and tapering hole in catheter drainage in hypertensive cerebral hemorrhage（HCH）.Methods：A total of 312 HCH patients who need catheter drainage from 2012 to 2016 were selected and divided into boring hole group and tapering hole group randomly,156 patients in each group.The patients in boring hole group were punctured after their brain cortex exposed fully in the air,the patients in tapering hole group were punctured directly from the puncturing spots.The subsequent treating principles and methods were same.The currative effect in two groups were compared.Results：There was no obvious difference between the two groups in the bleeding of the puncturing tract.The death rate of tapering hole group was 12.82%,little higher than boring hole group7.69%,but the difference was not significant statistically.The amount of bleeding in the boring hole group was obviously more than that in the tapering hole group,but the operation time of tapering hole group was obviously less than that in the boring hole group（P〈0.05）.The incidence rate of cortical surface bleeding,subdural hematoma and epidural hematoma was much higher than that in the boring hole group（P 〈0.05）.There were no significant statistically differences in the rate of unplanned extubation（UEX）,intracranial infection,cerebrospinal fluid（CSF）leakage,drainage tube displace between the two groups.Conclusion：Both of the boring hole and tapering hole have their advantages and disadvantages in the usage of the clinical medicine.We should choose the correct way according to the patients′situation,but boring hole can possibly avoid the cortical surface bleeding,subdural hematoma and epidural hematoma,it is recommended to popularize in tolerated patients.

关 键 词：钻孔 锥孔 高血压脑出血 

分 类 号：R651.1[医药卫生—外科学]