CT辅助定向软通道穿刺术治疗高血压小脑出血的研究

发布时间：2018-06-20 13:58

本文选题：高血压病 + 小脑出血　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:高血压小脑出血是临床上常见的脑血管疾病,其发病快,病情凶险,故病死率、致残率极高,内科保守治疗效果差,应用适当的外科治疗手段可降低患者的死亡率及致残率,本课题通过比较、分析CT辅助定向软通道穿刺术与后颅窝开颅血肿清除术,两种不同术式治疗高血压小脑出血的临床疗效,并发症及预后情况,以希望为高血压小脑出血的外科治疗提供一定的帮助。方法:回顾并分析我院自2008年01月--2014年06月收治的经CT辅助定向软通道穿刺术与开颅血肿清除术,两种不同术式治疗高血压小脑出血临床资料,合计40例,将患者分为两组,穿刺组(给予CT辅助定向软通道穿刺术)共12例和手术组(给予后颅窝开颅血肿清除术)共28例,对两组患者手术时间、血肿清除率、术后再出血率、肺部感染、皮下积液、术后脑积水等临床进行分析比较,应用SPSS13.0统计软件进行处理并分析,计量资料的统计描述懫取均数±标准差(sx±)表示,两组间的比较采用t检验,计数资料的统计描述采取率或构成比,组间比较采用卡方检验进行分析,确定检验水准a=0.05。P0.05差异有统计学意义。结果:(1)两组患者术前临床特征方面,年龄:穿刺组60.92±7.98;手术组57.33±6.73P=0.169。性别:穿刺组男性8例占66.70%女性4例占33.30%;手术组男性17例占60.71%女性11例占39.30%;P=1.00。术前GCS评分穿刺组8.92±2.43手术组9.22±2.21 P=0.715。术前出血量穿刺组17.64±3.33手术组19.41±3.74P=0.178;差异无统计学意义(P0.05)。(2)术后两组患者手术时间的比较,穿刺组55.58±8.37分,手术组208.61±25.94分P0.01;术后GOS评分,穿刺组4-5分8例占66.67%,手术组4-5分9例32.10%P=0.043;术后患者血肿清除率(3天内拔管时)的比较,穿刺组90%以上8例占66.67%,80-90%1例占8.33%,手术组90%以上10例占35.71%,80-90%17例占60.71%,P=0.004;P值均0.05,差异均有统计学意义。术后再出血率的比较,穿刺组1例占9.09%,手术组3例占10.71%P=0.430 P0.05,差异无统计学意义。(3)肺部感染发生率的比较,穿刺组2例16.67%,手术组15例53.57%P=0.030;术后颅内感染生率的比较,穿刺组无颅内感染,手术组8例28.57%P=0.038;皮下积液发生率比较,穿刺组无,手术组10例占35.71%P=0.046;P值均0.05,差异均有统计学意义。术后脑积水发生率比较,穿刺组3例占25.00%手术组:9例占32.14%P=0.946 P0.05,差异无统计学意义。结论:CT辅助定向软通道穿刺术治疗高血压小脑出血缩短了手术耗时,为危重患者的抢救赢得了宝贵的时间,手术创伤小,操作简单,减少了并发症,拓宽了手术适应证,提高患者生存质量,降低死亡率。是治疗小脑出血快速、简便、有效的方法,值得在临床上推广。
[Abstract]:Objective: hypertensive cerebellar hemorrhage is a common cerebrovascular disease in clinic. Proper surgical treatment can reduce the mortality and disability rate of the patients. Through comparison, this paper analyzes the CT assisted directional soft channel puncture and the posterior craniotomy hematoma removal. The clinical efficacy, complications and prognosis of two different surgical procedures for hypertensive cerebellar hemorrhage were discussed in order to provide some help for the surgical treatment of hypertensive cerebellar hemorrhage. Methods: the clinical data of 40 patients with hypertensive cerebellar hemorrhage treated by CT-assisted directional soft channel puncture and craniotomy were retrospectively reviewed and analyzed from January 2008 to June 2014. The patients were divided into two groups. There were 12 cases in the puncture group and 28 cases in the operation group. The operation time, hematoma clearance rate, postoperative rebleeding rate, pulmonary infection, subcutaneous effusion were compared between the two groups. Postoperative hydrocephalus and other clinical data were analyzed and compared. SPSS 13.0 statistical software was used to process and analyze. The statistical description of measurement data was expressed by mean 卤standard deviation (sx 卤), and the comparison between the two groups was performed by t test. The statistical description rate or composition ratio of counting data was analyzed by chi-square test to determine the test level (a0.05.05). Results in terms of preoperative clinical features, age: puncture group (60.92 卤7.98), operation group (57.33 卤6.73Pl) 0.169. Sex: in the puncture group, there were 8 males (66.70%), 4 females (33.30%) and 17 males (60.71%) in the operation group (11 cases) (39.30%). The preoperative GCS score was 8.92 卤2.43 in the puncture group and 9.22 卤2.21 in the operative group. The operative time of the two groups was 55.58 卤8.37 in the puncture group, 208.61 卤25.94 in the operation group, and 208.61 卤25.94 in the operation group (P 0.01). In the puncture group (4-5 points, 8 cases, 66.67%), the operation group (4-5 points, 9 cases, 32.10P0. 043; the postoperative hematoma clearance rate, extubation within 3 days), the puncture group (more than 90%) accounted for over 8 cases (66.67%, 80-901 cases, 8.33%), the operation group, more than 90% (10 cases, 35.71%, 80-90 cases, 60.71P = 0.004 P, 0.05), the difference was statistically significant. The rate of postoperative rebleeding was 9.09 in the puncture group and 10.71 in the operation group. There was no significant difference in the incidence of pulmonary infection between the puncture group (n = 2) and the operation group (n = 15). The incidence of intracranial infection was compared between the puncture group (n = 2) and the operation group (n = 15). There was no intracranial infection in the puncture group, and the incidence of subcutaneous effusion in the operation group was 28.57 and 0.038, but there was no subcutaneous effusion in the puncture group (P = 35.71, P = 0.046, P = 0.05, respectively), and the difference was statistically significant. The incidence of hydrocephalus after operation was 25.00% in the puncture group, 9 cases in the operation group and 32.14 P0.946 P0.05in the puncture group, the difference was not statistically significant. Conclusion the operation time is shortened and the time is gained for the treatment of hypertensive cerebellar hemorrhage by the use of soft channel puncture assisted with the use of the special soft channel. The surgical trauma is small, the operation is simple, the complications are reduced, and the indication of the operation is widened. Improve patients' quality of life and reduce mortality. It is a rapid, simple and effective method for the treatment of cerebellar hemorrhage.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12

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