微创穿刺引流联合开颅减压术治疗高血压脑出血并脑疝的临床研究  

Clinical study of minimally invasive puncture drainage combined with craniotomy and decompression in the treatment of hypertensive cerebral hemorrhage with cerebral hernia

作　　者：黄坚[1] 杜春生[1] 吴彬冰 谢嘉涛 李燕佳[1] HUANG Jian;DU Chun-sheng;WU Bin-bing;XIE Jia-tao;LI Yan-jia(Department of Brain Surgery,Puning Overseas Chinese Hospital,Jieyang 515300,Guangdong,CHINA)

机构地区：[1]揭阳市普宁华侨医院脑外科,广东揭阳515300

出　　处：《海南医学》2020年第7期854-857,共4页Hainan Medical Journal

基　　金：广东省揭阳市科技计划项目(编号:2018WSY1019)。

摘　　要：目的探讨微创穿刺引流联合开颅减压术治疗高血压脑出血并脑疝的疗效,为临床治疗提供参考依据。方法选择2018年8月1日至2018年12月31日揭阳市普宁华侨医院脑外科收治的46例高血压脑出血并脑疝患者进行研究,按照随机数表法分为观察组和对照组,每组23例。对照组给予开颅血肿清除并去骨瓣减压术治疗,观察组给予微创穿刺引流联合开颅血肿清除并去骨瓣减压术治疗。比较两组患者围术期情况、术后6个月预后情况及生活质量(采用SF-36简明生活质量量表评价)。结果观察组和对照组患者的手术时间[(93.34±8.51) min vs(136.21±7.69) min]、ICU留置时间[(4.47±0.58) d vs (6.51±1.05) d]、住院时间[(10.27±2.05) d vs (14.51±2.61) d]比较,观察组明显短于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者术中出血量[(95.10±7.23) mL vs(94.43±9.30) mL]比较差异无统计学意义(P>0.05);术后6个月时,观察组患者的预后良好率为65.22%,明显高于对照组的34.79%,差异有统计学意义(P<0.05);观察组和对照组患者的SF-36简明生活质量量表中的生理功能[(56.53±5.81)分vs (46.49±5.34)分]、生理职能[(55.01±4.74)分vs (48.16±4.59)分]、躯体疼痛[(56.68±5.05)分vs (50.43±4.24)分]、总体健康[(55.57±4.93)分vs (48.65±4.70)分]、活力[(52.21±4.64)分vs (46.19±4.72)分]、社会功能[(54.02±6.75)分vs (48.04±5.63)分]、情感职能[(57.05±4.61)分vs (51.13±4.86)分]、精神健康[(54.62±6.01)分vs (47.41±4.72)分]评分比较,观察组明显高于对照组,差异均有统计学意义(P<0.05)。结论微创穿刺引流联合开颅减压术治疗高血压脑出血并脑疝可明显缩短手术时间,促进术后恢复,改善患者生活质量,临床治疗效果显著。Objective To study the clinical efficacy of minimally invasive puncture drainage combined with craniotomy and decompression in the treatment of hypertensive cerebral hemorrhage with cerebral hernia. Methods A total of 46 patients of hypertensive cerebral hemorrhage with cerebral hernia, who admitted to Department of Brain Surgery, Puning Overseas Chinese Hospital from August 1, 2018 to December 31, 2018, were selected and divided into the observation group and the control group according to random number table method, with 23 patients in each group. The control group was treated with removal of hematoma by craniotomy combined with decompressive craniectomy, while the observation group was treated with minimally invasive puncture drainage combined with removal of hematoma by craniotomy and decompressive osteotomy. The perioperative condition, prognosis and quality of life after operation 6 months(36-item short-form, SF-36) were compared between the two groups. Results The operation time, ICU retention time, hospitalization time in the observation group were(93.34±8.51) min,(4.47±0.58) d,(10.27±2.05) d, which were significantly shorter than corresponding(136.21±7.69) min,(6.51±1.05) d,(14.51±2.61) d in the control group(all P<0.05);the intraoperative bleeding volume was(95.10±7.23) m L in the observation group vs(94.43±9.30) mL in the control group(P>0.05). After 6 months of operation, the good prognosis rate of the observation group was 65.22%,which was significantly higher than 34.79% of the control group(P<0.05);the scores of physiological function, physiological function, physical pain, overall health, vitality, social function, emotional function, and mental health of SF-36 simple quality of life scale in the observation group were(56.53±5.81) points,(55.01±4.74) points,(56.68±5.05) points,(55.57±4.93) points,(52.21±4.64) points,(54.02±6.75) points,(57.05±4.61) points,(54.62±6.01) points, respectively,which were significantly higher than corresponding(46.49 ± 5.34) points,(48.16 ± 4.59) point

关 键 词：高血压脑出血 脑疝 微创穿刺引流 开颅血肿清除术 去骨瓣减压术 

分 类 号：R743.34[医药卫生—神经病学与精神病学]