简易锥颅穿刺血肿或脑室引流术与开颅手术治疗高血压性脑出血的对比研究

Comparison of the effect on drainage of hematoma by awl or ventriculopunture and clearance of hematoma by craniotomy in treatment of hypertensive cerebral hemorrhage

目的对比简易锥颅穿刺血肿或脑室引流术与开颅手术治疗高血压性脑出血的疗效。方法 206例具有手术指征的脑出血患者随机分成两组,锥颅组100例于神经内科采取简易锥颅穿刺血肿或脑室引流术治疗,开颅组106例于神经外科行开颅手术治疗,观察两组患者的疗效及并发症。结果血肿<60ml,术前GCS>7分者采用简易锥颅穿刺血肿引流术或脑室引流术的病死率低于和预后优良率高于开颅手术组(P<0.05)。其重要的并发症有肺部感染、急性肾功能衰竭和消化道出血,本研究显示其并发症锥颅组明显低于开颅组,其中肺部感染锥颅组发生率(11%)低于开颅组(60%,P<0.05)。结论简易锥颅穿刺血肿引流术或脑室引流术治疗高血压性脑出血不但疗效确切,而且有效减少了手术并发症,或避免了已有并发疾病的加重,提高了手术成功率和预后优良率,值得临床推广应用。

Objective To compare the drainage of hematoma by awl or ventriculopunture and surgical treatment of hypertensive cerebral hemorrhage. Methods 206 patients with operation indications divided into two groups, a group of 100 cases to the physician to take a clearance of hematoma by awl or ventriculopunture, the other 106 cases with neurosurgery operation, the effects and complications of the two groups were compared. Results Hematoma less than 60ml and GCS〉7 points with drainage of hematoma by awl or ventriculopunture has a lower mortality and higher the prognosis to operation group （P〈0. 05）. Its important complications involve lung infection, acute kidney failure, success and abnormal bleeding. This research shows that the complication in the awl or ventriculopunture group is lower than the surgery group. The lung infection rate of the awl group is 11% lower than that of surgical operation group,which is 60% （P〈 0.05）. Conclusion Drainage of hematoma by awl or ventriculopunture to make the treatment of hypertensive cerebral hemorrhage not only has exactly effect, but also effectively reduced the operation or avoid complications have concurrent illness, and improve the operation of insertion and the prognosis, it is worth promoting.