钻孔引流联合开颅血肿清除治疗高血压幕上脑出血的疗效  

Curative effects of drilling and drainage combined with craniotomy for hematoma removal in the treatment of hypertensive supratentorial intracerebral hemorrhage

作　　者：侯启凤 熊震[1] 邓莉莎[1] HOU Qifeng;XIONG Zhen;DENG Lisha(Department of Neurosurgery,the Affiliated Hospital,Chengdu University of Traditional Chinese Medicine,Chengdu 610072)

机构地区：[1]成都中医药大学附属医院神经外科,成都610072

出　　处：《郑州大学学报（医学版）》2022年第1期87-92,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：中医药管理局基金项目(lc20160225)。

摘　　要：目的:分析钻孔引流联合开颅血肿清除治疗高血压幕上脑出血的疗效。方法:将133例高血压幕上脑出血患者按手术方式分为联合组(钻孔引流联合开颅血肿清除,n=76)、对照组(钻孔引流,n=57);术后24 h,评估2组疗效,检测血清金属蛋白酶组织抑制因子-1(TIMP-1)、基质金属蛋白酶9(MMP-9)水平;术后2周评价神经功能及其他术后指标;术后3个月采用改良Rinkin量表(mRS)、格拉斯哥预后评分(GOS)评价预后。结果:术后24 h,联合组血肿清除率[(83.63±5.95)%vs(62.66±9.66)%]及病情好转率(48.68%vs 28.07%)高于对照组(P<0.05);2组血清TIMP-1、MMP-9水平均下降,且联合组的降幅高于对照组(P<0.05)。术后2周,2组临床神经功能缺损评分及言语、肢体肌力维度评分均下降(P<0.05),2组间降幅差异无统计学意义(P>0.05);2组肺部感染、颅内感染率差异无统计学意义(P>0.05),联合组再出血发生率低于对照组,NICU停留时间则较对照组长(P<0.05)。术后3个月,联合组mRS评分低于对照组,GOS高于对照组(P<0.001)。结论:钻孔引流联合开颅血肿清除治疗高血压幕上脑出血疗效确切,但较单纯钻孔引流,联合治疗并未获得更显著的神经功能、短期预后改善获益。Aim:To analyze the curative effects of drilling and drainage combined with craniotomy for hematoma removal in the treatment of hypertensive supratentorial intracerebral hemorrhage.Methods:A total of 133 patients with hypertensive supratentorial intracerebral hemorrhage were allocated into combined group(drilling and drainage combined with craniotomy for hematoma removal,n=76)and control group(drilling and drainage,n=57)according to the operation method.Curative effects of the 2 groups were evaluated at 24 hours after operation,and serum tissue inhibitor of metalloproteinase-1(TIMP-1)and matrix metalloproteinase 9(MMP-9)levels were determined.Neurological function and other postoperative indicators of the 2 groups were evaluated at 2 weeks after operation.Prognosis was evaluated at 3 months after operation.Results:At 24 hours after operation,the hematoma clearance rate and improvement rate in the combined group were significantly higher than those in the control group[(83.63±5.95)%vs(62.66±9.66)%,48.68%vs 28.07%](P<0.05).Serum TIMP-1 and MMP-9 were reduced in both groups,however,the decline in TIMP-1 and MMP-9 in the combined group was greater than that in the control group(P<0.05).Two weeks after operation,the scores of clinical neurological deficits,language and limb muscle strength of the 2 groups were reduced(P<0.05),but there was no statistical difference in the decline between the 2 groups(P>0.05).There was no significant difference in the rate of pulmonary infection or intracranial infection between the 2 groups(P>0.05).The incidence of rebleeding in the combined group was lower than that in the control group,and the NICU stay was longer than that of the control group(P<0.05).Three months after operation,the modified Rinkin scale score of the combined group was lower than that of the control group,and the Glasgow outcome scale was higher than that of the control group(P<0.001).Conclusion:Drilling and drainage combined with craniotomy for hematoma removal is effective in treating hypertensive supratentoria

关 键 词：高血压幕上脑出血 钻孔引流 开颅血肿清除 

分 类 号：R743.34[医药卫生—神经病学与精神病学]