血肿腔穿刺引流结合去骨瓣减压治疗基底节区脑出血7例

Puncture and drainage of hematoma cavity combined with bone flap decompression in the treatment of 7 cases of basal ganglia intracerebral hemorrhage

目的 评价血肿腔穿刺引流结合去骨瓣减压对基底节区脑出血手术疗效及安全性。方法 回顾性研究2017年7—12月在云南迪庆藏族自治州人民医院,对7例高血压基底节区大量脑出血重症病人施行血肿腔穿刺引流结合去骨瓣减压手术,术后评估病人CT影像脑中线移位改善程度,意识水平格拉斯哥昏迷指数(GCS)恢复程度,术后病人生存质量,记录手术进行时间以及手术出血量,手术前后资料采用配对资料非参数检验。结果 该7例病人经过本手术后,术前GCS评分为(4.85±1.06)分,术后1周后改善为(10.85±1.21)分(P=0.017);术前中线移位为(11.28±1.79)mm术后次日恢复为(4.85±1.06)mm(P=0.014);术后3个月GOS评分均大于3分;手术进行时间小于2 h;手术出血量均小于200 mL。结论 对基底节区脑出血病人行血肿腔穿刺结合去骨瓣减压术可有效缓解脑组织移位,改善意识障碍,同时又可减少手术创伤缩短手术时间。

Objective To valuate the efficacy and safety of hematoma puncture and drainage combined with decompression of bone flap for basal ganglia intracerebral hemorrhage.Methods The retrospective study was conducted in the People’s Hospital of DiqingTibetan Autonomous Prefecture,Yunnan Province from July to December 2017,seven patients with severe intracerebral hemorrhage inthe basal ganglia region of hypertension were treated with hematoma puncture and drainage combined with decompressive surgery to re-move bone flap.The improvement degree of line shift in the brain of CT images,the recovery degree of consciousness level GCS,thepostoperative quality of life of the patients were evaluated.The average duration of surgery and the average amount of surgical bleeding were recorded.The data before and after operation were analyzed by paired data nonparametric test.ResultAfter the operation,themean preoperative GCS score of the 7 patients was(4.85±1.06),and it was improved to(10.85±1.21) one week after the operation(P=0.017).The median preoperative midline shift was(11.28±1.79) mm,and it was recover to(4.85±1.06) mm the next day after surgery(P=0.014).3 months after surgery,the GOS scores were all greater than 3 points.Operation time was less than 2 hours.The operative blood loss was less than 200 m L.Conclusions For patients with basal ganglia intracerebral hemorrhage,hematoma cavity puncture com-bined with bone flap decompression can effectively alleviate the brain tissue displacement,improve the disturbance of consciousness,and reduce the surgical trauma and shorten the operation time.