开颅血肿清除联合钻孔引流术治疗高血压脑出血

Craniotomy with hematoma evacuation combined with borehole drainage in the treatment of hypertensive cerebral hemorrhage

目的对比单纯开颅血肿清除术与联合钻孔引流术治疗高血压脑出血(HICH)的临床疗效。方法采用回顾性研究方法,选取石家庄市第一医院2014年12月至2017年8月收治的100例HICH患者作为研究对象,依据手术方式不同分为对照组40例,采用单纯开颅血肿清除术治疗;观察组60例,采用开颅血肿清除术联合钻孔引流治疗。比较两组患者术后首次血肿清除速率、并发症发生率、神经功能变化及近期疗效。结果对照组患者术后首次血肿清除率为(52. 6±6. 0)%低于观察组的(79. 9±7. 8)%,差异有统计学意义(P <0. 01);术后对照组患者肺部感染、水电解质代谢平衡紊乱发生率均高于观察组(P <0. 05);术后两组患者再出血、颅内感染发生率比较,差异无统计学意义(P> 0. 05);术后3个月对照组患者神经功能缺损评分为(13. 1±1. 4)分高于观察组的(8. 8±1. 2)分(P <0. 01);术后6个月对照组患者格拉斯哥预后评分(GOS=5分)预后良好率低于观察组(P <0. 05)。结论采用开颅血肿清除术联合钻孔引流治疗效果优于单纯开颅血肿清除术,能提高血肿清除率,减少并发症发生,改善患者神经功能和近期预后。

Objective To compare the clinical efficacy of simple craniotomy with hematoma evacuation and combined it with borehole drainage in the treatment of hypertensive intracerebral hemorrhage（HICH） to provide a choice for clinical treatment. Methods A total of 100 HICH patients admitted in First Hospital of Shijiazhuang from December 2014 to August 2017 were selected as research objects. According to surgery methods,the patients were divided into control group（n = 40） in which the simple craniotomy with hematoma evacuation was used and observation group（n = 60） in which craniotomy hematoma evacuation combined with borehole drainage was used. The first hematoma removal rate,incidence of complications,nerve function changes and short-term effects were compared in two groups. Results The first hematoma removal rate in control group was significant lower than that in observation group [（52. 6 ± 6. 0） % vs（79. 9 ± 7. 8） %,P〈0. 01]. After surgery,the incidences of pulmonary infection and hydro-electrolyte metabolism balance disorder in control group were significantly higher than those in observation group（all P〈0. 05）. There were no significant differences in incidences of re-bleeding and intracranial infection between the two groups（all P〈0. 05）. After surgery,the neurological deficit score in control group was significantly higher than that in observation group（13. 1 ± 1. 4 vs 8. 8 ± 1. 2,P〈0. 01）.Rate of good outcome（GOS score = 5） 6 months after surgery in control group was significantly worse than that in observation group（P〈0. 01）. Conclusion The curative effect of craniotomy with hematoma evacuation combined with borehole drainage is better than simple craniotomy with hematoma evacuation,which can increase hematoma removal rate,reduce occurrence of complications,improve nerve function and facilitate prognosis.