微创穿刺引流术治疗高血压脑出血的预后分析

Prognostic analysis of minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage

目的探讨微创穿刺引流术与传统骨窗开颅术对高血压脑出血(HCH)患者并发症及预后的影响。方法选取2012年1月年至2017年1月我院收治的HCH患者160例,依据随机分配原则分为微创组和开颅组,每组80例,微创组给予微创穿刺引流术治疗,开颅组给予传统骨窗开颅术治疗。结果微创组术中出血量、术后住重症监护室(ICU)时间、并发症发生率和术后C反应蛋白(CRP)、白介素(IL-6)、B型脑钠肽(BNP)水平明显低于开颅组,微创组血肿清除率、治疗显效率明显高于开颅组,差异有统计学意义(P <0. 05);微创组格拉斯哥预后评分(GOS)预后不良率明显低于开颅组,差异有统计学意义(P <0. 05),微创组死亡率低于开颅组,但差异无统计学意义(P> 0. 05)。结论与传统骨窗开颅术比较,微创穿刺引流术可有效减少HCH患者手术创伤和术后再灌注脑损害、并发症,及可有效提高血肿清除效果,有利于提高患者的治疗疗效及预后水平,值得临床作进一步推广。

Objective The effect of the minimally invasive puncture drainage and traditional craniotomy for the complications and prognosis in patients with hypertensive cerebral hemorrhage（HCH） were discussed. Methods A total of 160 patients with HCH were selected from January 2012 to January 2017 in our hospital according to the random distribution,and all the patients were divided into minimally invasive group and craniotomy group with 80 cases in each. The patients in minimally invasive group were treated with minimally invasive puncture drainage,and in craniotomy group all the patients were treated with traditional craniotomy. Results The intra-operative blood loss,post-operative intensive care unit（ICU） time,complication rate and post-operative C-reactive protein（CRP）,interleukinin-6（IL-6）,B-type brain natriuretic peptide（BNP） levels of minimally invasive group were significantly lower than those of craniotomy group. The hematoma clearance rate and therapeutic efficiency rate of minimally invasive group were significantly higher than those of craniotomy group with statistically significant difference（P〈0.05）. The Glasgow outcome score（GOS） showed bad prognosis rate of minimally invasive group was significantly lower than that of craniotomy group,and the difference was statistically significant（P〈0. 05）. The death rate of minimally invasive group was lower than that of craniotomy group,but the difference was not statistically significant（P〉0. 05）. Conclusion Compared with traditional craniotomy,minimally invasive puncture drainage can effectively reduce the operation wound,the post-operative reperfusion of brain injury,and the complications in patients with HCH,and it can also effectively improve the haematoma removal effect in patients,the curative effect and prognosis,so it is worthy of further promotion in clinical practice.