早期分步控制性减压手术治疗重症高血压脑出血患者的疗效分析  

Application and effects of controlled decompression technology by steps along early stage in severe hypertension cerebral hemorrhage

作　　者：张开鑫 方宪清 程彪 吕爱宾 胡英明 王希 程志坚 宋泽武 李立新[2] ZHANG Kai-xin;FANG Xian-qing;CHENG Biao(Department of Neurosurgery,The People's Hospital of Huangshan City,Huangshan 245000,China)

机构地区：[1]安徽省黄山市人民医院神经外科,黄山245000 [2]南京医科大学第一附属医院神经外科

出　　处：《临床神经外科杂志》2020年第4期434-438,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(81171147);江苏省科教强卫工程医学重点人才研究基金(ZDRCA2016010);江苏省兴卫工程医学重点人才基金(RC201156)。

摘　　要：目的探讨早期分步控制性减压手术治疗重症高血压脑出血患者的临床疗效。方法将43例高血压脑出血患者按入院的先后顺序分为早期分步控制性减压手术组(分步减压组,21例)和对照组(22例)。分步减压组患者行早期分步控制性减压术清除血肿,对照组患者行传统开颅血肿清除术治疗。对两组患者术中去骨瓣率、术后并发症(术区渗血、脑梗死)发生率、不同时间的脑水肿体积,以及预后进行分析比较。结果两组患者的性别、年龄、术前血肿量、术前格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分的差异均无统计学意义。两组患者的术中去骨瓣率、术后脑梗死发生率和术后6个月病死率、预后不良率比较,差异均无统计学意义(均P>0.05)。与对照组比较,分步减压组患者的术区渗血率明显降低,术后6个月的格拉斯哥预后量表评分明显增高,差异均有统计学意义(均P<0.05)。两组患者术后不同时间之间的脑水肿体积的差异均有统计学意义(均P<0.001);而分步减压组术后不同时间的脑水肿体积又显著低于对照组(均P<0.001)。结论早期分步控制性减压手术治疗高血压脑出血操作简单、可行性强,较传统开颅血肿清除术的并发症少、术后脑水肿轻;可以在一定程度上改善患者的预后。Objective To investigate the feasibility and clinical efficacy of controlled decompression by steps along the early stage for severe hypertension cerebral hemorrhage.Methods A total of 43 eligible patients with hypertension cerebral hemorrhage were randomly divided into treatment group(steps decompression group,21 cases)and control group(22 cases),according to the order of admission.The controlled decompression was performed in the treatment group and conventional craniotomy in the control group.The clinical data,including the situation of the rate of bone flap,the rate of postoperative complications(postoperative bleeding and cerebral infarction),the volume of cerebral at different times and prognosis were described and analyzed.Results There was no statistically significant differences between two groups in patients age,gender,preoperative amount of hematoma and preoperative GCS scores.And there was also no statistically significant difference between the rate of intraoperative decompressive craniectomy and the rate of cerebral infarction after surgery and the rate of mortality and poor prognosis at 6 months after surgery between the two groups(P>0.05).The rate of Glasgow outcome scale in six months after operation in treatment group was remarkably increased and recurrent postoperative hemorrhage was significantly reduced as compared with the control group(P>0.05).The changes of edema volume between groups had statistically significant differences(P<0.001).At the same time edema volume in treatment group was significantly lower than the control group(P<0.001).Conclusion Gradual and controlled decompression in early stage for hypertension cerebral hemorrhage is easy to operate and feasible in clinical settings,that can reduce complications and brain edema compared with the control group,so finally improve the outcome in a certain extent.

关 键 词：脑出血 控制性减压 神经外科手术 临床疗效 

分 类 号：R651.1[医药卫生—外科学]