两种血肿清除联合置管引流术对急性脑出血伴脑室破入患者血肿清除效果及颅内感染风险的影响

Influence of two kinds of hematoma removal combined with catheter drainage on the hematoma clearance effects and the intracranial infection risk of patients with acute cerebral hemorrhage and ventricular rupture

目的探讨显微镜和神经内镜下血肿清除联合置管引流术对急性脑出血伴脑室破入患者血肿清除效果及颅内感染风险的影响。方法研究对象选取该院2016年2月-2018年2月收治的急性脑出血伴脑室破入患者共120例,以随机数字表法分为A组(40例)、B组(40例)及C组(40例),分别采用单纯脑室外引流、显微镜血肿清除+置管引流术和神经内镜血肿清除+置管引流术,比较3组患者手术用时、置管时间、随访血肿清除率、术后7 d格拉斯哥昏迷评分及颅内感染发生率。结果 B和C组患者手术时间明显长于A组(P<0.05);C组患者置管时间明显短于A和B组(P<0.05);3组患者随访脑实质血肿清除率比较,差异无统计学意义(P>0.05);C组患者随访脑室内血肿清除率明显高于A和B组(P<0.05);C组患者术后7 d格拉斯哥昏迷评分明显高于A和B组(P<0.05);同时C组患者颅内感染发生率明显低于A和B组(P<0.05)。结论相较于单纯脑室外引流和显微镜下血肿清除联合置管引流术,神经内镜下血肿清除联合置管引流术治疗急性脑出血伴脑室破入,可有效缩短置管时间,提高脑室内血肿清除效果,改善临床预后,并有助于预防颅内感染发生。

Objective To investigate the influence of hematoma removal combined with catheter drainage by microscopes and neuroendoscopy on the hematoma clearance effects and the intracranial infection risk of patients with acute cerebral hemorrhage and ventricular rupture.Methods 120 patients with acute cerebral hemorrhage and ventricular rupture in the period from February 2016 to February 2018 were chosen and randomly divided into 3 group including A group(40 patients)with catheter drainage used alone,B group(40 patients)with hematoma removal combined with catheter drainage by microscopes and C group(40 patients)with hematoma removal combined with catheter drainage by neuroendoscopy;and the operation time,catheterization time,hematoma clearance rate with follow-up,Glasgow coma score in 7d after operation and the intracranial infection incidence of both groups were compared.Results The operation time of B group and C group were significantly longer than A group(P<0.05).The catheterization time of C group were significantly shorter than A group and B group(P<0.05).There was no significant difference in the brain parenchyma hematoma clearance rate with follow-up among 3 groups(P>0.05).The intraventricular hematoma clearance rate with follow-up of C group were significantly higher than A group and B group(P<0.05).The Glasgow coma score in 7d after operation of C group were significantly higher than A group and B group(P<0.05).The intracranial infection incidence of C group were significantly lower than A group and B group(P<0.05).Conclusion Compared with catheter drainage used alone and hematoma removal combined with catheter drainage by microscopes,hematoma removal combined with catheter drainage by neuroendoscopy in the treatment of patients with acute cerebral hemorrhage and ventricular rupture can efficiently shorten the catheterization time,higher the intraventricular hematoma clearance effects,improve the clinical prognosis and be helpful to prevent the intracranial infection occurrence.