微创脑血肿穿刺引流联合颅内压监测治疗老年高血压性基底节区脑出血的临床研究

Clinical research of minimally invasive intracerebral hematoma puncture drainage combined with intracranial pressure monitoring in the treatment of senile hypertensive cerebral hemorrhage in basal ganglia

目的探讨微创脑血肿穿刺引流联合颅内压(ICP)监测治疗老年高血压性基底节区脑出血的临床疗效。方法回顾性分析63例老年高血压性基底节区脑出血患者的临床资料,根据治疗方式将患者分为微创脑血肿穿刺引流术组(A组,n=30)和微创脑血肿穿刺引流联合ICP监测组(B组,n=33)。对比分析两组患者的术中血肿抽吸量、抽吸量占比情况、术后7 d甘露醇平均用量、不同时间点格拉斯哥昏迷量表(GCS)评分、并发症发生率以及预后情况。结果与A组比较,B组患者术中血肿抽吸量明显增加,抽吸量占比明显提高,术后7 d甘露醇平均用量显著减少,术后3 d、7 d以及14 d的GCS评分明显改善(均P<0.05)。两组患者术后再出血、脑积水、癫痫、电解质紊乱、颅内感染、应激性溃疡发生率比较,差异均无统计学意义(均P>0.05)。B组的预后情况优于A组(P<0.05)。结论微创脑血肿穿刺引流联合ICP监测,能够显著增加术中血肿抽吸量,减轻占位效应,减少术后甘露醇平均用量,显著改善患者的意识障碍程度及预后,值得在老年高血压性基底节区脑出血患者中推广应用。

Objective To explore the clinical efficacy of minimally invasive intracerebral hematoma puncture drainage combined with intracranial pressure(ICP)monitoring for treating senile hypertensive cerebral hemorrhage in basal ganglia.Methods The clinical data of 63 senile patients with hypertensive cerebral hemorrhage in basal ganglia were retrospectively analyzed,and they were assigned to minimally invasive intracerebral hematoma puncture drainage group(group A,n=30),and minimally invasive intracerebral hematoma puncture drainage combined with ICP monitoring group(group B,n=33).The intraoperative hematoma aspiration volume,the states of aspiration volume proportions,the average amount of mannitol 7 days after operation,the Glasgow Coma Scale(GCS)scores at different time points,and the incidence of complications and the states of prognosis were compared and analyzed between the two groups.Results Compared with group A,patients in group B obtained significantly larger hematoma aspiration volume,prominently higher proportion of aspiration volume,whereas significantly less average amount of mannitol 7 days after operation,and more improved GCS scores 3,7,and 14 days after operation(all P<0.05).There were no statistically significant differences of the incidence in postoperative rehemorrhage,hydrocephalus,epilepsy,electrolyte disturbance,intracranial infection,and stress ulcer between the two groups(all P>0.05).The state of prognosis of group B was superior to group A(P<0.05).Conclusion Minimally invasive intracerebral hematoma puncture drainage combined with ICP monitoring can prominently increase intraoperative hematoma aspiration volume,reduce the mass effect and the postoperative average amount of mannitol,and significantly improve disturbance of consciousness and prognosis,which is worthy of promotion and application in senile patients with hypertensive cerebral hemorrhage in basal ganglia.