小骨瓣血肿清除术与穿刺引流术治疗高血压脑出血meta分析

发布时间：2018-07-04 12:37

本文选题：高血压脑出血 + 手术方式　；参考：《昆明医科大学》2015年硕士论文

【摘要】：目的分析已有的临床资料比较小骨瓣血肿清除术与穿刺引流术外科治疗高血压脑出血术式选择及术后日常生活能力是否有更好的疗效。方法对我院2013年7月至2015年3月66例小骨瓣血肿清除术与穿刺引流术高血压脑出血患者资料进行回顾性分析。针对患者GCS评分、出血部位、出血量及不同术式的关系进行统计学分析,比较术后患者预后情况。结果66例患者中采用小骨瓣开颅血肿清除术共47例。术前GCS评分8分以上46例,(约97.9%),GCS8分以下1例(2.1%)；基底节区出血31例,占65.9%,丘脑出血6例,占12.7%,小脑出血4例,占8.5%,皮层出血6例,12.8%：60～80m1占8例(17.0%),40-60m1占34例(72.3%),40m1占5例(10.6%)。采用穿刺引流术患者共19例。术前GCS评分13分以上占17例(89.5%),GCS9～12分占2例(10.5%)；丘脑出血并破入脑室8例,占42.1%,脑室出血11例占57.9%,60-80m1占1例(5.2%),40-60m1占16例(84.2%),40m1占2例(10.5%)。应用x2检验及spearman检验提示出血量、手术术式及出血部位具有明显相关性(p0,05)。术后6月对患者进行随访,针对预后ADL进行相关评分,穿刺引流术优于小骨瓣血肿清除术,死亡率小骨瓣血肿清除术优于穿刺引流术。结论患者预后均和术前GCS评分、出血部位、出血量密切相关。同时手术方式选择及手术时机的选择也严重影响患者预后的生活质量。目的分析已有的临床对照试验资料比较小骨瓣血肿清除术与穿刺引流术外科治疗高血压脑出血对术后日常生活能力是否有更好的疗效。方法按照系统评价的要求全面检索PubMed、Medline数据库、OVID、万方全文数据库、CNKI数据库、维普中文科技期刊数据库、CBM disk数据库、SCIENCEDIRECT数据库等。纳入所有小骨瓣开颅血肿清除术与穿刺引流术治疗高血压脑出血的随机对照试验,共纳入20个样本随机对照组,共计病例数4752例,对文献资料进行提取并进行质量评价。使用RevMan5.3对相关数据进行系统评价,使用Meta分析两种手术病死率及预后。结果Meta分析提示：1、超早期行手术治疗的高血压脑出血患者死亡率[P=0.02,OR合并=I.37,95%CI(0.29,6.59)],无统计学差异(P0.05)；2、术后6个月内日常生活能力(ADLI-Ⅲ级)。血肿穿刺引流术组优于小骨瓣血肿清除术组,[P=-0.25,OR-=2.47,95%CI(0.38,0.88)],P0.05,有统计学差异；3、死亡率：小骨瓣血肿清除术低于穿刺外引流术[P=0.24,0R合并=0.81,95%CI(0.66-0.98)],P0.05,有统计学差异；4、再出血率：穿刺外引流术与小骨瓣血肿清除术再出血率[P=0.27,OR合并=1.41,95%CI(0.76-2.61)],P0.05,无统计学差异：5、肺部感染率：小骨瓣血肿清除术高于穿刺外引流术[P=0.002,0R台并=1.8,95%CI(1.25-2.58)],P0.05,有统计学差异；6、消化道出血率：小骨瓣血肿清除术与穿刺外引流术消化道出血率[P=0.16,OR并-=1.44,95%CI(0.87-2.38)],P0.05,无统计学差异；7、尿路感染率：小骨瓣血肿清除术与穿刺外引流术尿路感染率[P=1.04,OR-=I.04,95%CI(0.55-1.99)],P0.05,无统计学差异；结论(1)、超早期手术治疗高血压脑出血总体死亡率,两种手术方式死亡率基本相同,无统计学差异。(2)、术后6个月内日常生活能力(ADLⅠ-Ⅲ级),血肿穿刺引流术优于小骨瓣血肿清除术。(3)、小骨瓣血肿清除术外科治疗高血压脑出血死亡率低于穿刺引流术。(4)、小骨瓣血肿清除术与穿刺引流术治疗高血压脑出血术后再出血率基本相同,无统计学差异。(5)、小骨瓣血肿清除术与穿刺引流术治疗高血压脑出血术后并发症中,肺部感染率穿刺引流术低于小骨瓣血肿清除术；消化道出血及尿路感染两种术式基本相同,无统计学差异。
[Abstract]:Objective to compare the existing clinical data to compare the surgical treatment of hypertensive intracerebral hemorrhage by small flap hematoma removal and puncture drainage and the better curative effect of postoperative daily living ability. Methods 66 cases of small bone flap hematoma clearance and puncture drainage of hypertensive cerebral hemorrhage from July 2013 to March 2015 in our hospital were carried out. Retrospective analysis. According to the GCS score, bleeding site, bleeding volume and the relationship between different surgical procedures, the prognosis of postoperative patients was compared. Results of the 66 patients, small bone flap craniotomy and hematoma removal were used in 47 cases. The preoperative GCS score was 8 or more, 46 cases (about 97.9%), 1 cases (2.1%) below GCS8, 31 in basal ganglia, 65. .9%, 6 cases of thalamic hemorrhage, 12.7%, 4 cases of cerebellar hemorrhage, 8.5% of cerebral hemorrhage, 6 cases of cortical hemorrhage, 8 cases (17%), 40-60m1 in 34 cases (72.3%), 5 cases (10.6%) with 40m1 and 5 cases (5 cases). The preoperative GCS score in 4 or more cases, GCS9 to the ventricle, cerebral hemorrhage and cerebral ventriculus 11 cases of ventricular hemorrhage accounted for 57.9%, 60-80m1 accounted for 1 cases (5.2%), 40-60m1 accounted for 16 cases (84.2%), and 40m1 accounted for 2 cases (10.5%). X2 test and Spearman test showed the bleeding volume, the surgical operation and bleeding site had obvious correlation (p0,05). In June, patients were followed up to evaluate the prognosis of ADL, and puncture drainage was superior to small bone petal hematoma clearance. Conclusion the prognosis of patients with small bone flap hematoma is better than that of puncture drainage. Conclusion the prognosis of the patients is closely related to the preoperative GCS score, the site of bleeding and the amount of bleeding. Meanwhile, the choice of operation and the choice of the time of operation also seriously affect the quality of life in the patient's prognosis. Surgery and puncture drainage surgery for hypertensive intracerebral hemorrhage has a better effect on postoperative daily living ability. Methods according to the requirements of systematic evaluation, PubMed, Medline database, OVID, Wanfang full text database, CNKI database, data base of VIP Chinese sci-tech periodicals, CBM disk database, SCIENCEDIRECT database, etc. are included. The randomized controlled trials of all small craniotomy craniotomy hematoma removal and puncture drainage in the treatment of hypertensive intracerebral hemorrhage were included in a total of 20 randomized controlled groups, with a total of 4752 cases, the literature was extracted and the quality was evaluated. The related data were evaluated with RevMan5.3, and the mortality of two kinds of operations was analyzed by Meta and Results Meta analysis showed that: 1, the mortality rate of hypertensive intracerebral hemorrhage in the ultra early stage was [P=0.02, OR combined with =I.37,95%CI (0.29,6.59)], without statistical difference (P0.05); 2, the daily living ability (ADLI- III) within 6 months after operation. The hematoma puncture drainage group was superior to the small bone flap hematoma clearance group, [P=-0.25, OR-=2.47,95%CI (0.38,) 0.88)], P0.05, there were statistical differences; 3, mortality: small bone flap hematoma clearance was lower than that of [P=0.24,0R combined with =0.81,95%CI (0.66-0.98)], P0.05, with statistical difference; 4, rebleeding rate: the rate of rebleeding was [P=0.27, OR combined =1.41,95%CI (0.76-2.61)], P0.05, no statistical difference. Difference: 5, the rate of pulmonary infection: small bone flap hematoma clearance was higher than that of external drainage [P=0.002,0R and =1.8,95%CI (1.25-2.58)], P0.05, with statistical difference; 6, the bleeding rate of digestive tract: small bone flap hematoma removal and puncture drainage of digestive tract bleeding rate [P=0.16, OR and =1.44,95%CI (0.87-2.38)], P0.05, no statistical difference; 7, urine. The rate of road infection: the rate of urinary tract infection [P=1.04, OR-=I.04,95%CI (0.55-1.99)], P0.05, there was no statistical difference between small bone flap hematoma clearance and external drainage. Conclusion (1) the mortality of hypertensive intracerebral hemorrhage was treated by ultra early operation, and the mortality of the two methods of operation was basically the same, no statistical difference. (2) the daily living ability in 6 months after the operation. (ADL I - III), hematoma puncture drainage is superior to small bone flap hematoma clearance. (3) small bone flap hematoma removal surgical treatment of hypertensive intracerebral hemorrhage mortality is lower than puncture drainage. (4), small bone flap hematoma removal and puncture drainage treatment of hypertensive intracerebral hemorrhage postoperative rebleeding rate is basically the same, no statistical difference. (5) small bone petal hematoma clear clear In the treatment of postoperative complications of hypertensive intracerebral hemorrhage, the pulmonary infection rate was lower than that of small bone flap hematoma, and the two types of digestive tract bleeding and urinary tract infection were basically the same, with no statistical difference.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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