颅内压监护下颞部置管血肿外引流术的疗效及卫生经济学分析  

Efficacy and Health Economics Analysis of External Drainage of Temporal Catheterization Hematoma Assisted by Intracranial Pressure Monitoring

作　　者：刘政委 仪立志 尹夕龙 彭玉平[2] 纠智松 LIU Zhengwei;YI Lizhi;YIN Xilong;PENG Yuping;JIU Zhisong(Department of Neurosurgery,Longgang Central Hospital(Shenzhen Clinical Medical College,Guangzhou University of Traditional Chinese Medicine,Shenzhen 518116,China;Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]深圳市龙岗中心医院(广州中医药大学深圳临床医学院神经外科,广东深圳518116 [2]南方医科大学南方医院神经外科,广东广州510515

出　　处：《中国实用神经疾病杂志》2019年第23期2622-2628,共7页Chinese Journal of Practical Nervous Diseases

基　　金：深圳市知识创新计划项目(编号:JCYJ20170306140444161)

摘　　要：目的探讨颅内压监护辅助下颞部锥颅软通道置管并血肿外引流术(微创手术)与保守药物治疗高血压基底节脑出血(25~30 mL)的临床疗效、并发症和卫生经济学差别。方法 120例(25~30 mL)基底节脑出血患者随机被分为微创组和保守组各60例。比较2组的再出血率,偏瘫好转率,肺部感染,压疮,血肿吸收时间,及住院时间和住院费用等指标。结果微创组再出血率(3.3%)明显低于保守组(16.7%),差异有统计学意义(P<0.05);微创组的肢体偏瘫的好转率(75%)高于保守组(55%),差异有统计学意义(P<0.05);微创组肺部感染和压疮发生率明显低于保守组,差异有统计学意义(P<0.05);微创组的血肿吸收时间(7.5±2.08)d,明显短于保守组的(22.0±4.73)d,差异有统计学意义(P<0.05),且微创组的住院日(13.5±2.90)d和住院费用(4.5±0.46)万元,优于保守组的(27.8±6.53)d、(7.6±1.38)万元,2组比较差异有统计学意义(P<0.01)。结论颅内压监护辅助下的颞部锥颅软通道置管联合血肿外引流术,在治疗中等量的(25~30 mL)基底节脑出血的时候,优于保守治疗方案。Objective To explore differences in clinical efficacy and health economics on basal ganglia intracerebral hematomas with the volume of 25~30 mL between the initial conservative treatment and minimally invasive surgery,with which we stereotacticly put a soft external drainage tube(with intracranial pressure monitoring probe) into cerebral hematoma through a hole drilled in the temporal skull.Methods 120 cases of basal ganglia cerebral hematomas with volume between 25~30 mL were observed and recorded.60 cases were randomLy divided into surgery group and a control group of 60 patients.Rehaemorrhage rate,improvement rate of hemiplegia,pulmonary infection,pressure sore,absorption time of hematoma,hospitalization time and hospitalization expenses were observed and compared between the two groups.These data were collected and analyzed by SPSS 19.0.Results Hematoma volume increase rate in the control group(16.7%) was significantly higher than the surgery group(3.3%),but hematoma disappeared significantly faster than the control group.The incidence of pulmonary infection and pressure sore in the surgery group was significantly lower than that in the conservative group(P<0.05).The total length of hospitalized day in the surgery group was significantly shorter than the control group(P<0.05).Conclusion In the treatment of a small amount(25-30 mL) aspects of basal ganglia intracerebral hemorrhage,this minimally invasive surgical treatment with the continuous monitoring intracranial pressure is a better way to select than conservative treatment.

关 键 词：颅内压监护 软通道 保守治疗 基底节脑出血 经济学 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R615.1[医药卫生—临床医学]