不同直径脑窥镜行微创颅内血肿碎吸术的效果比较

Effects comparison of microtrauma broken suction operations of intracerebral hematoma with different diameters of brain endoscope

目的观察改良微创直视颅内血肿碎吸术与未改良者救治高血压性脑出血脑疝(HIHE)的死亡率、致残率及对脑温的影响比较。方法61例患者,随机分为两组:治疗组31例,改良NK-1纤维脑窥镜(窥镜及螺旋棒直径=4mm)行微创直视颅内血肿碎吸术,抽吸血肿70%～80%,生理盐水冲洗,腔内注入尿激酶150U,置入引流管,术后检测脑温,点式温度计的放置时间为4～5d;对照组30例,仍用NK-1纤维脑窥镜(窥镜及螺旋棒直径=6mm)抽吸,治疗方法及点式温度计放置同治疗组。两组术后均以脱水、支持疗法为主。以两组治疗结束为统计界限。以两组病死率、再出血、生存者神经功能缺损(NDS)与日常生活能力评定(ADL)、脑温为观察指标。结果治疗组病死率显著低于对照组(P<0.05);两组生存者NDS与ADL比较治疗组降低更明显(P<0.01);两组比较治疗组脑温明显降低(P<0.05);两组再出血率比较差异显著(P<0.05)。结论改良微创直视颅内血肿碎吸术能降低HIHE病死率、再出血率,提高生存者NDS和ADL,是救治HIHE较理想的方法。

Objective To observed the mortality and disabled rate and brain temperature change after treatment of hypertensive intracerebral hemorrhage encephalocele(HIHE)by improved and unimproved microtrauma open intracerebral hematoma broken suction operation (BSO).Methods The61patients were random divided into two groups.The treated group (31cases)was subjected to microtrauma open intracerebral hematoma BSO(the diameter of sight glass and spiral stick equal to4mm)by the improved NK-1fibre brain endoscope.The70%-80%of haematoma was pumped.Sodium chloride irrigation was used.The150U urokinase was injected into the cavity then drainage tube was put into it.The Brain temperature was measured by point style thermometer.The deposited time was4-5d.The controlled group(30cases)underwent the unimproved BSO(the diameter,6mm).The pumped and treated methods and point style thermometer placed were as same as the treated group.Dehydration and supportion were the main treatment methods in two group after operation.Statistic limit was the treatment end of two groups.The observation index was mortality,rebleeding,neurological deficiency score(NDS)and activity of daily living(ADL),and brain temperature of the survival.Results The mortality of treated group was lower than the controlled group(P<0.05).The NDS and ADL of treated group reduced significantly than the controlled group (P<0.01).The brain temperature of treated group dropped significantly than the controlled group(P<0.05).The rebleeding rate of treated group was lower than the controlled group(P<0.05)significantly.Conclusion The improved mircotrauma open BSO of intracerebral hematoma can reduce the mortality,reblecding rate,and can increase NDS,ADL of the survival.It is the ideal method to cure HIHE.