梯度减压改良手术法治疗高血压脑出血的效果及对脑膨出的预防作用

The effect of gradient decompression modified surgery on HICH and its preventive effect on brain bulging

目的探讨梯度减压改良手术治疗高血压脑出血(HICH)的效果及对脑膨出的预防作用。方法选取2015年5月至2016年8月收治的136例HICH患者进行回顾性研究,根据手术方法分为改良组70例(开路后采用脑穿针抽吸梯度减压、血肿清除术)、常规组66例(开颅后大范围快速减压、血肿清除术)。比较两组患者术中血肿清除率、格拉斯哥昏迷评分(GOS)、美国国立卫生研究院卒中量表评分(NIHSS)、日常生活活动能力(ADL)评分及患者的预后情况。结果改良组患者术中血肿清除率高于常规组患者,差异有统计学意义(P<0.05);术前、术后7 d,改良组患者与常规组患者的NIHSS评分、GOS评分变比较,差异无统计学意义(P>0.05);改良组患者术后14 d、术后28 d的NIHSS评分低于常规组(P<0.05);两组患者术后各时间点的NIHSS评分较术前显著的降低(P<0.05),GOS评分较术前显著的提高(P<0.05);术后3个月,改良组患者ADL评分低于常规组(P<0.05);术后6个月,两组患者的ADL评分差异无统计学意义(P>0.05)。术前,两组患者的血清S100B蛋白、NSE的水平比较差异无统计学意义(P>0.05);术后7 d,改良组患者的血清S100B蛋白、NSE的水平显著的低于常规组(P<0.05)。改良组患者发生术中脑膨出发生率(1.43%)、迟发性脑出血发生率(1.43%)均低于常规组的10.61%、12.12%(P<0.05)。结论梯度减压改良手术治疗HICH患者血肿清除效果好,同时有利于患者预后恢复、减少脑膨出的发生。

Objective To investigate the effect of modified decompression for hypertensive intracerebral hemorrhage（ HICH） and the prevention of encephalocele. Methods A total of 136 cases of HICH patients in our hospital department of Neurosurgery treatment（ May 2015 to August 2016） were retrospectively studied,according to the operation method they were divided into two groups,70 cases of modified group（ after craniotomy,the brain puncture suction gradient decompression and hematoma evacuation was performed）,66 cases of normal group（ after craniotomy,a wide range of rapid decompression and hematoma evacuation was performed）. Glasgow Coma Scale（ GOS）,National Institutes of Health Stroke Scale（ NIHSS） and the prognosis of the patients in the two groups were compared. Results The difference of the surgical hematoma removal rate between the two groups was not statistically significant（ P〈0. 05）; 7 days before and after surgery,NIHSS score and GOS score change between the two groups were significantly different（ P〈0. 05）; 14 days and 28 days after surgery,NIHSS score of improved group patients was lower than that of the conventional group（ P〈0. 05）; at each time point,the NIHSS score of improved group after operation was significantly lower than that before operation（ P〈0. 05）,while GOS score increased（ P〈0. 05）; 3 months after surgery,ADL score of modified group was lower than that of the conventional group（ P〈0. 05）; Before the operation,the two groups had no statistical significant differcnce in serum S100 B protein and NSE level（ P〈0. 05）; 7 days after operation,serum S100 B protein and NSE levels in modified group were significantly lower than those of conventional group（ P〈0. 05）. 6 months after surgery,there was no significant difference in ADL score of the two groups（ P〈0. 05）; The rate of encephalocele（ 1. 43%） and delayed cerebral hemorrhage（ 1. 43%） in modified group were lower than those the normal group group,10. 61% and 12. 12% respectively（ P〈0. 05）. Conclusion Gradient decompression improves the surgical evacuation rate in patients with HICH,and is beneficial to the prognosis and the incidence of brain swelling.