多点穿刺联合局部亚低温灌洗引流治疗老年重症高血压脑出血的效果

Effect of multi-point puncture plus local hypothermia drainage treating the elder severe hypertensive intracerebral hemorrhage

目的探讨多点穿刺联合局部亚低温灌洗引流(MPPLHD)治疗老年重症高血压脑出血的效果。方法选取我院2011年6月~2016年12月收治的81例老年重症高血压脑出血患者为研究对象,按患者情况及家属意愿分为传统开颅血肿清除(CC)组(n=44)、MPPLHD组(n=37)。CC组采用标准大骨瓣开颅清除血肿术,MPPLHD组采用MPPLHD。比较两组患者的血肿清除率、颅内压,第3、5、7天、血液NSE浓度、神经功能缺失评分(NDS)及日常生活能力(ADL)评分。结果 MPPLHD组首次血肿清除率低于CC组(P<0.05),术后第3、5天的血肿清除率明显高于CC组(P<0.05)。MPPLHD组术后第3、5、7天的脑水肿相当增量及血液NSE浓度均明显低于CC组(P<0.05),术后28 d、3个月、6个月的NDS、ADL评分均优于CC组(P<0.05)。结论 MPPLHD可有效清除血肿,减少术后神经功能缺失,是治疗老年重症高血压脑出血的有效方法。

Objective To explore the effect of multi-point puncture plus local hypothermia drainage （MPPLHD） treating the eider severe hypertensive intracerebral hemorrhage.Methods From June 2011 to December 20/6,81 eider patients with severe hypertensive intracerebral hemorrhage were selected as object and they were divided into MPPLHD group （n=37） and conventional craniotomy group （CC group,n=44） according to the patient situation and family wishes.In CC group,removal of hematoma by standard large bone flap craniotomy was adopted.MPPLHD group was treated with MP- PLHD.Hematoma clearance rate,intracranial pressure,brain edema with considerable increment at the third,fifth,seventh day,blood NSE concentration,neurological deficit score （NDS） and activity of daily living （ADL） score were compared between the two groups.Results The first hematoma evacuation rate in MPPLHD group was lower than that in the CC group （P〈0.05）,the hematoma evacuation rate after the third,fifth day operation in MPPLHD group was higher than those in CC group （P〈0.05）.Brain edema with considerable increment at the third,fifth,seventh day and blood NSE concentration in MPPLHD group were obviously lower than that of CC group （P〈0.05）.After 28 days,3 and 5 months operation,NDS and ADL score in MPPLHD group were better than those of CC group （P〈0.05）.Conclusion MPPLHD can effectively remove hematoma and reduce the loss of postoperative nerve function.It is an effective method for the treatment of elder severe hypertensive cerebral hemorrhage.