钻孔引流术与开颅血肿清除术治疗中等量高血压脑出血的效果及安全性比较

Comparative analysis on efficacy and safety of BHID and craniotomy evacuation of hematoma in the treatment of moderate amount of hypertensive intracerebral hemorrhage

目的比较钻孔引流术与开颅血肿清除术治疗中等量高血压脑出血(HICH)的疗效与安全性。方法将阳煤集团总医院2015年8月至2018年8月收治的56例中等量HICH患者随机分为钻孔组与开颅组,每组28例。比较两组患者术后动态颅内压变化、手术时间、术后恢复情况、术后并发症、神经功能功能及日常生活能力等指标。结果两组颅内压水平在术后即刻至术后48 h呈上升趋势,在术后48h至术后7d呈下降趋势,但钻孔组上升及下降幅度均小于开颅组,差异有统计学意义(P<0.05);开颅组术后即刻及术后24、48h颅内压水平均低于钻孔组(P<0.05)。钻孔组手术时间、意识恢复时间、下床活动时间及术后住院时间均少于开颅组(P均<0.05);钻孔组术后并发症发生率低于开颅组(P<0.05)。与术前比较,两组患者术后14 d神经功能缺损(肢体肌力与语言能力方面)评分均降低(P<0.05),术后3个月日常生活能力(ADL)评分均提高;钻孔组术后14 d神经功能缺损(肢体肌力与语言能力方面)评分低于开颅组(P<0.05),术后3个月ADL评分高于开颅组(P<0.05)。结论相较于开颅血肿清除术,中等量HICH患者可选择钻孔引流术治疗,能够在更短时间内获得更好的手术效果与预后效果,降低并发症风险,安全有效。

Objective To compare the efficacy and safety of burr holes irrigation and drainage(BHID)and craniotomy evacuation of hematoma in the treatment of moderate amount of hypertensive intracerebral hemorrhage(HICH).Methods Fifty-six patients with moderate amount of HICH hospitalized in Yangmei Group General Hospital from August 2015 to August 2018 were randomly divided into trepanation group and craniotomy group,with 28 cases in each group.The dynamic intracranial pressure changes,operative time,postoperative recovery,postoperative complications,neurological function and activity of daily living(ADL)were compared between the two groups.Results The intracranial pressure levels in the two groups were increased immediately after operation until 48 h after operation,and then the intracranial pressure decreased 48 h after operation until 7 d after operation,but the increase and decrease in trepanation group were smaller than those in craniotomy group(P<0.05).The intracranial pressure in craniotomy group was significantly lower than that in trepanation group immediately after operation and at 24 h and 48 h after operation(P<0.05).The operative time,consciousness recovery time,ambulation time and postoperative hospital stay in trepanation group were significantly shorter than those in craniotomy group(P<0.05).The incidence of postoperative complications in trepanation group was significantly lower than that in craniotomy group(P<0.05).Compared with preoperative scores,the scores of neurological deficit(limb muscle strength and language ability)in the two groups were significantly decreased 14 d after operation(P<0.05),and the ADL scores were significantly improved 3 months after operation.The neurological deficit(limb muscle strength and language ability)scores in trepanation group were significantly lower than those in craniotomy group 14 d after operation(P<0.05),and the ADL score in trepanation group was significantly higher than that in craniotomy group 3 months after operation(P<0.05).Conclusions Compared with craniotomy evacuation of hematoma,BHID can achieve better surgical results and prognosis effects in a shorter time and reduce risk of complication for patients with moderate amount of HICH,which is safe and effective.