颅内压监测下控制性减压在开颅血肿清除术治疗重症脑出血患者中的应用价值研究  

Controlled decompression under intracranial pressure monitoring in craniotomy of patients with severe cerebral hemorrhage

作　　者：费振海 阳建国[1] 钟兴明[1] 汪一棋[1] 赵朝辉[1] 蔡勇[1] 张磊[1] 顾华[1] 杨涛[1] 刘卫兰[1] 唐坎凯[1] 陈志冬[1] Fei Zhenhai;Yang Jianguo;Zhong Xingming;Wang Yiqi;Zhao Zhaohui;Cai Yong;Zhang Lei;Gu Hua;Yang Tao;Liu Weilan;Tang Kankai;Chen Zhidong(Department of Neurosurgery, First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou 313000, China)

机构地区：[1]湖州市第一人民医院(湖州师范学院附属第一医院)神经外科,313000

出　　处：《中华神经医学杂志》2019年第5期494-500,共7页Chinese Journal of Neuromedicine

基　　金：浙江省医药卫生科技计划项目(2019KY678);浙江省湖州市科技计划项目(2018GYB64).

摘　　要：目的探讨颅内压监测下控制性减压在开颅血肿清除术治疗重症脑出血患者中的应用价值。方法前瞻性纳入自2015年1月至2018年7月入住湖州师范学院附属第一医院神经外科的106例重症脑出血患者,依据患者家属意愿将患者分为对照组(51例)和治疗组(55例)。对照组采取传统的开颅血肿清除术治疗;治疗组在颅内压监测下采取控制性减压联合开颅血肿清除术治疗,同时术后进行颅内压监测管理。对比分析2组患者的术中骨瓣回纳率,术后再出血、头皮渗液、颅内感染、脑梗死等并发症的发生率,术后再次手术率及伤后6个月格拉斯哥预后评分。结果研究过程中中途退出5例(对照组2例、治疗组3例),最后纳入统计分析例数为101例(对照组49例、治疗组52例)。治疗组患者术中骨瓣回纳率(69.2%)较对照组(24.5%)明显提高,术后再出血、头皮渗液、颅内感染及脑梗死等并发症发生率(11.5%、7.7%、3.8%、13.5%)较对照组(30.6%、22.4%、16.3%、34.7%)均明显降低,术后再次手术率(3.8%)较对照组(16.3%)明显降低,预后良好率(76.9%)较对照组(55.1%)明显提高,死亡率(7.7%)较对照组(22.4%)明显降低,差异均有统计学意义(P<0.05)。结论对于重症脑出血患者,颅内压监测下控制性减压联合开颅血肿清除术治疗可明显提高患者骨瓣回纳率,减少二期颅骨修补率,减少术后再出血、脑梗死等并发症发生率及术后再次手术率,更有效地改善患者的生存质量及预后。Objective To explore the value of controlled decompression under intracranial pressure monitoring in craniotomy of patients with severe cerebral hemorrhage. Methods One hundred and six patients with severe cerebral hemorrhage, admitted to our hospital from January 2015 to July 2018, were prospectively enrolled. These patients were divided into control group (n=51) and treatment group (n=55) according to their families' wishes. The patients in the control group were treated with traditional craniotomy and hematoma removal;the patients in the treatment group were treated with controlled decompression combined with craniotomy and hematoma clearance under intracranial pressure monitoring, and intracranial pressure monitoring and management were carried out after operation. The rate of bone flap acceptance during operation, incidences of complications such as re-bleeding, scalp exudation, intracranial infection and cerebral infarction after operation, rate of re-operation and Glasgow outcome scale scores 6 months after injury were compared and analyzed between the two groups. Results Five patients had midway withdrawal (2 from the control group and3 from the treatment group), and 101 patients (49 from the control group and 52 from the treatment group) were included in the statistical analysis. The rate of bone flap acceptance in the treatment group (69.2%) was significantly higher than that in the control group (24.5%, P<0.05). The incidences of complications such as bleeding, scalp exudation, intracranial infection and cerebral infarction (11.5%, 7.7%, 3.8%, and 13.5%) were significantly lower than those in the control group (30.6%, 22.4%, 16.3%, and 34.7%, P<0.05). The re-operation rate (3.8%) was significantly lower than that in the control group (16.3%, P<0.05). Good recovery rate in the treatment group (76.9%) was significantly higher than that in the control group (55.1%, P<0.05). The mortality rate (7.7%) was significantly lower than that of the control group (22.4%, P<0.05). Conclusion For patients with severe

关 键 词：脑出血 颅内压监测 控制性减压 开颅血肿清除术 

分 类 号：R651.1[医药卫生—外科学]