微创钻孔软通道引流术治疗脑室出血的临床效果及术后再出血的影响因素

Clinical effect of minimally invasive drilling and soft channel drainage in the treatment of intraventricular hemorrhage and the influencing factors of postoperative rebleeding

目的:探讨微创钻孔软通道引流术治疗脑室出血的临床效果及术后再出血的影响因素。方法:南京市浦口区中医院于2016年6月至2021年2月收治的118例脑室出血患者随机分为对照组与研究组。对照组给予开窗血肿清除术治疗,研究组给予微创钻孔软通道引流术治疗。比较2组手术状况、血压神经功能及术后再出血的发生率,采用logistic回归分析再出血的影响因素。结果:研究组手术时间和住院时间均短于对照组(均P<0.001),手术治疗总有效率高于对照组(P<0.001)。2组治疗后收缩压和舒张压均降低(均P<0.001),研究组术后血压低于对照组(均P<0.001)。研究组术后美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分低于对照组(P<0.001),巴塞尔(Barthel)指数高于对照组(P<0.001)。术前收缩压和发病到接受手术的时间间隔均为术后再出血的独立危险因素(均P<0.05)。结论:脑室出血患者应用微创钻孔软通道引流术可有效降低血压,减轻神经损伤,降低术后再出血发生率,是术后再出血的保护因素。

Objective: To explore the clinical effect of minimally invasive drilling and soft channel drainage in the treatment of intracerebral hemorrhage and the influencing factors of postoperative rebleeding.Methods: A total of 118 patients with intraventricular hemorrhage admitted from June 2016 to February 2021 in Pukou District Hospital of raditional Chinese Medicine were randomly divided into a control group and a study group. The control group was treated with fenestration hematoma clearance, and the study group was treated with minimally invasive drilling soft channel drainage. The surgical conditions, blood pressure, nerve function, and the incidence of postoperative rebleeding were compared between the 2 groups. The influencing factors of rebleeding was analyzed with logistic regression analysis.Results: The operation time and hospitalization time of the study group were both lower than those of the control group(both P<0.001), the total effective rate of surgical treatment in study group was higher than that in the control group(P<0.001). Systolic blood pressure and diastolic blood pressure were decreased in both groups after treatment(all P<0.001), and the blood pressure in the study group was lower than that in the control group(P<0.001). The National Institutes of Health Stroke Scale(NIHSS) score of the study group was lower than that of the control group(P<0.001), and the Barthel index was higher than that of the control group(P<0.001). Preoperative systolic blood pressure and the time interval from onset to operation were independent risk factors for postoperative rebleeding(both P<0.05).Conclusion: The application of minimally invasive drilling and soft channel drainage in patients with ventricular hemorrhage can effectively reduce blood pressure, reduce nerve injury and incidence of postoperative rebleeding, which is a protective factor for postoperative rebleeding.