高血压中等量脑出血小骨窗开颅血肿清除与微钻孔血肿腔置管引流对比研究

Comparative study of craniotomy via small bone flap and trepanation and drainage in treatment of moderate hypertensive cerebral hemorrhage

目的比较小骨窗开颅血肿清除与微钻孔血肿腔置管引流治疗高血压中等量脑出血的疗效及预后。方法选取我院2011-06—2013-06收治的高血压中等量脑出血患者120例,采用随机数字表法随机分为研究组(n=60)和对照组(n=60)。对照组实施小骨窗开颅血肿清除术治疗,研究组采取微钻孔血肿腔置管引流术治疗,观察比较两种治疗方法的疗效、手术过程和预后情况。结果对照组总有效率为85.00%(51/60)与研究组83.33%(50/60)相比差异无统计学意义(χ2=3.742,P>0.05)。研究组手术时间、清除血肿量和住院时间分别为(0.81±0.44)h、(33.23±10.02)mL、(27.89±9.03)d;对照组手术时间、清除血肿量和住院时间分别为(1.31±0.34)h、(35.89±9.81)mL、(30.12±8.99)d,2组比较除手术时间差异有统计学意义(t=6.97,P<0.05)外,其余差异均无统计学意义(t=1.47,1.35,P>0.05)。对照组术后再出血2例,颅内感染4例,电解质紊乱10例,呼吸道感染7例,消化道出血13例,与研究组的2、3、6、4、7例比较无明显差异(2χ=0.405,P>0.05)。对照组患者治疗后预后好转率为83.33%(50/60),恢复率为66.67%(40/60),病死率为1.67%(1/60),与研究组的83.33%(50/60)、65.00%(39/60)、1.67%(1/60)比较无明显差异(2χ=0,0.037,P>0.05)。结论两种手术方法疗效、并发症、预后均无差异,但微钻孔血肿腔置管引流手术时间短,可以更好地抢救危及患者,是较佳的选择。

Objective To compare the clinical effect and prognosis between craniotomy via small bone flap and trepanation and drainage in treatment of moderate hypertensive cerebral hemorrhage.Methods 120 cases with moderate hypertensive cere‐bral hemorrhage in our hospital from June 2011 to June 2013 were selected and divided into the study group （n=60） and control group （n=60） according to random number table. The control group received craniotomy via small bone flap ,while study group was given trepanation and drainage. Finally the clinical effect and prognosis were analyzed and compared in two groups.Results The total effective rate of patients was 85.00% （51/60）in the control group and 83.33% （50/60） in control group ,with no statistical difference （χ2 =3.742 ,P〉0.05）. The operation time ,the volume of hematoma and the duration of hospital stays re‐spective were （0.81 ± 0.44） h ,（33.23 ± 10.02） mL ,（27.89 ± 9.03） d in study group and （1.31 ± 0.34） h ,（35.89 ± 9.81） mL ,（30.12 ± 8.99） d in control group ,only operation time has a statistical difference （t=6.97 ,P〈0.05）. 2 cases were com‐plicated with postoperative bleeding ,3 cases with intracranial infection ,6 cases with electrolyte imbalance ,4 cases with respira‐tory tract infection ,7 cases with gastrointestinal bleeding in study group ,and there was no statistical difference compared with control group （χ2 =0.405 ,P〉0.05）. In prognosis ,improvement rate ,recovery rate and mortality rate were respective 83.33 %（50/60） ,66.67% （40/60）and 1.67% （1/60）in control group ,while 83.33% （50/60） ,65.00% （39/60） ,1.67% （1/60）in study group ,with no significant differences （χ2 =0.037 ,P〉0.05）.Conclusion The effect of surgical technique ,complication ,prog‐nosis have no difference between two groups. However ,operation time in trepanation and drainage is shorter ,you can better rescue dangerous patients ,which should be a better choice.