开颅血肿清除联合脑室外引流治疗高血压脑出血破入脑室的疗效

发布时间：2018-03-31 16:26

  本文选题：脑出血　切入点：高血压　出处：《第二军医大学学报》2017年04期

【摘要】：目的探讨开颅血肿清除联合脑室外引流和单纯脑室外引流治疗高血压脑出血破入脑室的疗效。方法回顾性分析2012年6月至2015年6月3年内我院收治的70例接受手术治疗的高血压脑出血破入脑室患者的临床资料,其中脑室外引流联合开颅血肿清除(EVD+HE组)患者31例,单纯脑室外引流(EVD组)39例。比较两组患者的格拉斯哥昏迷评分(GCS)、神经外科重症监护室(NICU)住院天数、死亡率、肺部感染、颅内感染和再出血的发生率以及随访6个月后的改良Rankin量表(mRS)评分及格拉斯哥预后评分(GOS)。然后筛选比较两组中幕上血肿量30mL患者的上述临床指标。结果术后住院期间EVD+HE组9例(29.0%)患者死亡,EVD组2例(5.1%)死亡,差异有统计学意义(P=0.008);其余存活患者继续纳入后续研究。EVD+HE组患者GCS评分增加值(ΔGCS)大于EVD组(P0.05);两组患者NICU住院时间,术后再出血及肺部感染、颅内感染发生率,随访6个月后mRS及GOS评分的差异无统计学意义(P0.05)。EVD+HE组幕上血肿量30mL的患者ΔGCS、术后6个月mRS及GOS评分均优于EVD组(P0.05),但NICU住院时间、术后再出血及肺部感染、颅内感染发生率与EVD组相比差异无统计学意义(P0.05)。结论对于幕上血肿量30mL的患者,开颅血肿清除联合脑室外引流术疗效优于单纯脑室外引流术。
[Abstract]:Objective to evaluate the efficacy of craniotomy combined with ventricular drainage and ventricular drainage in the treatment of hypertensive intracerebral hemorrhage. Methods 70 patients with hypertensive intracerebral hemorrhage admitted to our hospital during the three years from June 2012 to June 2015 were retrospectively analyzed. Clinical data of patients with hypertensive intracerebral Hemorrhage broken into ventricle, Among them, 31 cases were treated with ventricular drainage combined with craniotomy and hematoma clearance (EVD HE group) and 39 cases with simple ventricular drainage (EVD group). The Glasgow coma score (Glasgow coma score), the days of stay in neurosurgery intensive care unit (NICU), the mortality rate, and pulmonary infection were compared between the two groups. The incidence of intracranial infection and rebleeding and the modified Rankin scale mRSs and Glasgow prognosis score were evaluated after 6 months follow up. Then the two groups of patients with supratentorial hematoma volume (30mL) were selected and compared. Results the patients were hospitalized after operation. During which 9 patients died in the EVD HE group and 2 patients died in the EVD group. The difference was statistically significant (P < 0. 008). The other surviving patients continued to be included in the follow-up study. The increased value of GCS score (螖 GCSs) in the EVD-HE group was higher than that in the EVD group (P 0.05). The duration of NICU hospitalization, postoperative rebleeding and pulmonary infection, and the incidence of intracranial infection were observed in the two groups. There was no significant difference in the scores of mRS and GOS after 6 months follow-up. There was no significant difference in 螖 GCSs between the patients with 30mL of supratentorial hematoma volume in the EVD-HE group. The scores of mRS and GOS at 6 months after operation were better than those in the EVD group (P 0.05), but the hospitalization time of NICU, postoperative rebleeding and pulmonary infection were better than those in the EVD group. There was no significant difference in the incidence of intracranial infection between the EVD group and the EVD group. Conclusion for the patients with supratentorial hematoma volume 30mL, the curative effect of craniotomy combined with ventricular drainage is better than that of simple ventricular drainage.
【作者单位】： 第二军医大学长征医院神经外科;
【基金】：国家自然科学基金(81371382) 上海市“领军人才”计划(2012049) 上海市科技人才计划(15XD1504700)~~
【分类号】：R544.1;R651.12
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本文编号：1691522