微创双管置入治疗高血压脑出血的临床评价
发布时间：2018-10-22 20:34
【摘要】：目的研究与比较不同术式(微创双管置入引流术联合尿激酶注入与传统开颅血肿清除术)、不同手术时机(超早期手术与早期手术)治疗高血压脑出血的疗效。方法回顾性分析唐山市丰润区医院神经外科2013年1月~2015年1月收治的高血压脑出血急性期患者64例,其中开颅血肿清除术患者25例(包括超早期手术6例,早期组19例);微创双管置入术39例(其中超早期组25例,早期组14例)。记录患者人口学特征(年龄、性别、血肿部位和血肿深度);采用格拉斯哥意识障碍评分(Glasgow Coma Scale,GCS)评估入院时和发病后1 w意识水平;记录首次血肿清除率、血肿消失时间、手术时间和住院天数;出院后死亡率、再出血情况及并发症情况。采用格拉斯哥预后量表(Glasgow outcome scale,GOS)和日常生活能力评分(Daily life ability score,ADL)评估患者术后6月的生活质量。。结果与传统开颅血肿清除术比较,微创双管置入引流术联合尿激酶注入能够显著:1降低手术时间和住院天数,差异具有统计学意义(χ2=115.698,P=0.000;χ2=11.199,P=0.000);2减低术后并发症发生率,差异具有统计学意义(χ2=5.517,P=0.023);3降低出院后死亡率(χ2=4.675,P=0.031);4改善预后,出院6个月患者GOS大于等级4以上者与传统开颅血肿清除术组比较,差异具有统计学意义(χ2=4.441,P=0.035);5促进患者生活质量的提高,出院6个月患者ADL评分大于40分以上者与传统开颅血肿清除术组比较,差异具有统计学意义(χ2=4.582,P=0.032)。而微创手术超早期与早期手术相比,在术后GCS评分、首次血肿清除率、手术时间、住院天数、术后并发症发生率、出院后死亡率、术后GOS和ADL评分方面差异无统计学意义(P0.05)。结论微创双管置入术联合尿激酶注入较传统的开颅血肿清除术能够有效降低术后并发症和住院时间,改善患者预后和生活质量,同时超早期进行微创手术对于治疗高血压脑出血来讲较为安全、有效。
[Abstract]:Objective to study and compare the effects of different surgical procedures (minimally invasive double-tube drainage combined with urokinase injection and traditional craniotomy for hematoma removal) and different operative time (ultra-early operation and early operation) in the treatment of hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods from January 2013 to January 2015, 64 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed in the neurosurgery department of Fengrun District Hospital of Tangshan, including 25 patients with craniotomy and hematoma clearance (including 6 cases of ultra-early operation). There were 19 cases in the early stage group and 39 cases in the minimally invasive double tube implantation group (25 cases in the super early group and 14 cases in the early group). The demographics (age, sex, location and depth of hematoma) were recorded, Glasgow consciousness disorder score (Glasgow Coma Scale,GCS) was used to assess the consciousness level at admission and 1 week after onset, the clearance rate of the first hematoma and the time of hematoma disappearance were recorded. Operative time and hospital stay, mortality, rebleeding and complications after discharge. Glasgow prognosis scale (Glasgow outcome scale,GOS) and ADL score (Daily life ability score,ADL) were used to evaluate the quality of life (QOL) 6 months after operation. Results compared with traditional craniotomy and hematoma removal, minimally invasive double-tube drainage combined with urokinase injection could significantly reduce the operative time and hospital stay (蠂 ~ 2 / 115.698P ~ (0.000), 蠂 ~ (2 +) 11.199 / P ~ (0.000), reduce the incidence of postoperative complications. The difference was statistically significant (蠂 ~ 2 / 5.517p ~ (0.023), (3) the mortality rate after discharge (蠂 ~ (2) = 4.675) was decreased (蠂 ~ (2) = 4.675), (4) the prognosis was improved, the difference was statistically significant (蠂 ~ (2 +) 4.441P _ (0.035), (5) the quality of life was improved in patients whose GOS was greater than grade 4 (n = 6) than that in the traditional craniotomy group (蠂 ~ (2 +) 4.441P0.035). There was a significant difference between the patients with ADL score more than 40 months after discharge and the traditional craniotomy group (蠂 2 = 4.582 P < 0.032). However, there was no significant difference in postoperative GCS score, first hematoma clearance rate, operation time, hospital stay, postoperative complication rate, mortality rate after discharge, postoperative GOS and ADL score between early and early stage of minimally invasive surgery (P0.05). Conclusion minimally invasive double tube implantation combined with urokinase injection can effectively reduce postoperative complications and hospital stay and improve the prognosis and quality of life of patients compared with traditional craniotomy. At the same time, ultra-early minimally invasive surgery is safe and effective in the treatment of hypertensive intracerebral hemorrhage.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.11
，
本文编号：2288240
[Abstract]:Objective to study and compare the effects of different surgical procedures (minimally invasive double-tube drainage combined with urokinase injection and traditional craniotomy for hematoma removal) and different operative time (ultra-early operation and early operation) in the treatment of hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods from January 2013 to January 2015, 64 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed in the neurosurgery department of Fengrun District Hospital of Tangshan, including 25 patients with craniotomy and hematoma clearance (including 6 cases of ultra-early operation). There were 19 cases in the early stage group and 39 cases in the minimally invasive double tube implantation group (25 cases in the super early group and 14 cases in the early group). The demographics (age, sex, location and depth of hematoma) were recorded, Glasgow consciousness disorder score (Glasgow Coma Scale,GCS) was used to assess the consciousness level at admission and 1 week after onset, the clearance rate of the first hematoma and the time of hematoma disappearance were recorded. Operative time and hospital stay, mortality, rebleeding and complications after discharge. Glasgow prognosis scale (Glasgow outcome scale,GOS) and ADL score (Daily life ability score,ADL) were used to evaluate the quality of life (QOL) 6 months after operation. Results compared with traditional craniotomy and hematoma removal, minimally invasive double-tube drainage combined with urokinase injection could significantly reduce the operative time and hospital stay (蠂 ~ 2 / 115.698P ~ (0.000), 蠂 ~ (2 +) 11.199 / P ~ (0.000), reduce the incidence of postoperative complications. The difference was statistically significant (蠂 ~ 2 / 5.517p ~ (0.023), (3) the mortality rate after discharge (蠂 ~ (2) = 4.675) was decreased (蠂 ~ (2) = 4.675), (4) the prognosis was improved, the difference was statistically significant (蠂 ~ (2 +) 4.441P _ (0.035), (5) the quality of life was improved in patients whose GOS was greater than grade 4 (n = 6) than that in the traditional craniotomy group (蠂 ~ (2 +) 4.441P0.035). There was a significant difference between the patients with ADL score more than 40 months after discharge and the traditional craniotomy group (蠂 2 = 4.582 P < 0.032). However, there was no significant difference in postoperative GCS score, first hematoma clearance rate, operation time, hospital stay, postoperative complication rate, mortality rate after discharge, postoperative GOS and ADL score between early and early stage of minimally invasive surgery (P0.05). Conclusion minimally invasive double tube implantation combined with urokinase injection can effectively reduce postoperative complications and hospital stay and improve the prognosis and quality of life of patients compared with traditional craniotomy. At the same time, ultra-early minimally invasive surgery is safe and effective in the treatment of hypertensive intracerebral hemorrhage.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.11
，
本文编号：2288240
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2288240.html
最近更新
教材专著
