改良Paine点穿刺在高血压性脑出血经翼点开颅术中治疗脑室出血的应用价值  

Value of improved Paine point puncture in the treatment of intraventricular hemorrhage during transpterional craniotomy for hypertension intracerebral hemorrhage

作　　者：田和平 王耿焕 沈和平 周海航 TIAN Heping;WANG Genghuan;SHEN Heping;ZHOU Haihang(Department of Neurosurgery,the Second Hospital of Jiaxing,Jiaxing 314000,China;不详)

机构地区：[1]嘉兴市第二医院神经外科,314000 [2]嘉兴市第二医院感染科,314000

出　　处：《浙江医学》2024年第5期501-505,511,共6页Zhejiang Medical Journal

基　　金：浙江省医学会临床科研基金项目(2021ZYC-A150)。

摘　　要：目的 探讨改良Paine点穿刺在高血压性脑出血经翼点开颅术中治疗脑室出血的应用价值。方法 回顾性纳入2020年5月至2022年8月嘉兴市第二医院收治的行经翼点开颅血肿清除联合脑室穿刺引流术的78例高血压性脑出血患者的临床资料,按照脑室穿刺手术方法的不同,分为观察组(38例)和对照组(40例),其中观察组行手术切口内改良Paine点脑室穿刺引流,对照组行对侧切口经Kocher点脑室钻孔引流。比较两组患者的手术指标(手术用时、术中失血量)、疗效指标(穿刺通道出血率、带管时间、脑室出血清除率、颅内感染率)、预后指标[术后1个月时格拉斯哥昏迷评分(GCS)和美国国立卫生院卒中量表(NIHSS)评分]。结果 观察组患者手术用时、术中失血量、穿刺通道出血率、带管时间、颅内感染率均小于对照组(均P<0.05),且其术后第5天脑室出血清除率大于对照组(P<0.05);术后1个月存活的患者中,两组GCS、NIHSS比较差异均无统计学意义(均P>0.05)。结论 相较于传统的对侧切口经Kocher点脑室钻孔引流术,高血压性脑出血翼点开颅术中应用同侧切口内改良Paine点穿刺治疗脑室出血可提高脑室出血清除率,缩短手术用时及带管时间,降低术后穿刺通道出血率及颅内感染率,且并不加重患者的神经功能损伤程度。Objective To explore the application value of improved Paine point ventriculocentesis in the treatment of ventricular hemorrhage by transpterional craniotomy in hypertensive cerebral hemorrhage.Methods Retrospective clinical data of 78 patients with hypertensive intracerebral hemorrhage treated by transpterional cranitomy with hematoma removal combined with ventricular puncture and drainage who were admitted to the Second Hospital of Jiaxing from May2020 to August 2022.Based on the different methods of ventriculocentesis,patients were divided into study group(n=38)and control group(n=40).The study group was treated with improved Paine point ventriculocentocentesis drainage inside the incision,while the control group was treated with ventriculocentocele drainage through contralateral incision at the Kocher point.The two groups were compared in terms of surgical parameters(surgical duration,and intra-operative blood loss),efficacy measures(puncture-path bleeding rate,duration of tube use,clearance of ventricular hemorrhage,and intracranial infection rate),and prognosis [Glasrow coma score(GCS) and National Institute of Health stroke scale(NIHSS) at one month after surgery].Results The study group was evidently smaller than the control group in surgical duration,intra-operative blood loss,puncture-path bleeding rate,duration of tube use,and intracranial infection rate(P <0.05),and had a great rate of clearance of ventricular hemorrhage on postoperative day 5 than the control group(P>0.05).There was no significant difference in GCS score and NIHSS score between the two groups among patients who survived one month after surgery(both P>0.05).Conclusion Compared with the traditional ventricle drilling and drainage through contralateral incision at the Kocher point,the application of improved Paine point puncture inside the incision in the treatment of intraventricular hemorrhage in the transperional craniotomy for hypertensive cerebral hemorrhage can improve clearance of ventricular hemorrhage,shorten surgical duration

关 键 词：高血压脑出血 脑室出血 经翼点开颅术 脑室钻孔引流术 改良Paine点脑室穿刺 

分 类 号：R651.12[医药卫生—外科学]