开颅血肿清除术和钻孔引流术治疗中等量基底核区高血压脑出血的临床疗效比较研究  

Comparative Study of Clinical Efficacy of Craniotomy and Craniopuncture in Treating Moderate-volume Hypertensive Intracerebral Haemorrhage in Basal Ganglia

作　　者：孙昭胜 赵旺淼 葛春燕 张万增 李晓卫 SUN Zhao-sheng;ZHAO Wang-miao;GE Chun-yan;ZHANG Wan-zeng;LI Xiao-wei(Department of Neurosurgery,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学附属哈励逊国际和平医院神经外科,河北省衡水市053000

出　　处：《中国全科医学》2018年第6期702-706,共5页Chinese General Practice

基　　金：河北省科技计划项目(16277799D)

摘　　要：背景目前常见的治疗高血压脑出血的手术方式有开颅血肿清除术和钻孔引流术,但临床对手术方式的选择存在争议。目的比较开颅血肿清除术和钻孔引流术治疗中等量(30~60 ml)基底核区高血压脑出血患者的临床疗效,探讨最佳的手术方式。方法选取2012年1月—2016年6月河北医科大学附属哈励逊国际和平医院收治的符合研究标准的中等量(30~60 ml)基底核区高血压脑出血患者176例,其中稳定性脑出血90例、活动性脑出血86例。将稳定性脑出血患者应用随机数字表法分为稳定性脑出血开颅血肿清除术组(A组)46例和稳定性脑出血钻孔引流术组(B组)44例;活动性脑出血患者应用随机数字表法分为活动性脑出血开颅血肿清除术组(C组)42例和活动性脑出血钻孔引流术组(D组)44例。A、C组均行开颅血肿清除术,B、D组患者均行钻孔引流术。比较A组和B组、C组和D组术后再出血率及入院后6个月改良Rankin量表(m RS)评分、日常生活能力(以Barthel指数评定)、死亡情况。结果 A、B组患者术后再出血率以及入院后6个月m RS评分、Barthel指数、病死率比较,差异无统计学意义(P>0.05)。C组患者术后再出血率以及入院后6个月m RS评分、病死率均低于D组,入院后6个月Barthel指数高于D组(P<0.05)。结论在中等量基底核区高血压脑出血患者中,稳定性脑出血患者适宜行钻孔引流术治疗,其操作简单,创伤较小;活动性脑出血患者适宜行开颅血肿清除术治疗,能够降低术后再出血率、病死率,改善预后。术前对基底核区高血压脑出血患者进行合理的分类是非常必要的。Background At present,the most common surgical methods for hypertensive intracerebral haemorrhage(ICH)are haematoma removal by craniotomy and craniopuncture,but controversies exist about the choice of the two surgical methods.Objective To explore a better surgical method,this study was designed to compare clinical efficacy of haematoma removal by craniotomy and craniopuncture in treating moderate-volume(30-60 ml)hypertensive ICH in basal ganglia.Methods A total of 176 patients treated in Harrison International Peace Hospital Affiliated to Hebei Medical University with moderate volume(30-60 ml)hypertensive ICH in basal ganglia from January 2012 to June 2016 were recruited according to the inclusion criteria,including 90 cases of stable ICH and 86 cases of active ICH.The patients of stable ICH and active ICH were respectively divided into stable ICH treated by craniotomy group(group A,n=46)and stable ICH treated by craniopuncture group(group B,n=44),active ICH treated by craniotomy group(group C,n=42)and active ICH treated by craniopuncture group(group D,n=44)in accordance with the random number table.Groups A and C received haematoma removal by craniotomy,and groups B and D underwent craniopuncture.The rebleeding rate after operation,postoperative fatality rate and modified Rankin Scale(mRS)and activities of daily living(Barthel index)at 6 months after admission were compared between group A and group B and between group C and group D.Results There were no significant differences in rebleeding rate after operation,fatality rate,mRS and Barthel index between group A and group B(P>0.05).The rebleeding rate after operation,fatality rate and mRS in group C were lower than those in group D(P<0.05),and the Barthel index was higher than that in group D(P<0.05).Conclusion In patients with moderate-volume hypertensive ICH in basal ganglia,the stable ICH patients can benefit from craniopuncture,which is simple and can reduce surgical injury;for the active ICH patients,haematoma removal by craniotomy is reasonable,which can

关 键 词：颅内出血 高血压性 稳定性脑出血 活动性脑出血 外科手术 手术后出血 疗效比较研究 

分 类 号：R743.34[医药卫生—神经病学与精神病学]