高血压性丘脑出血破入脑室伴梗阻性脑积水的手术临床疗效及分析

发布时间：2019-01-28 18:05

【摘要】：目的观察单纯侧脑室穿刺置管引流术和神经内镜下血肿清除术两种手术方式治疗高血压性TH并破入脑室伴幕上急性梗阻性脑积水的临床效果,为高血压TH破入脑室伴急性梗阻性脑积水患者的临床手术治疗,提供选择依据。方法完全依照纳入与排除标准,并加以回顾性调查的方式,选取自2010年01月至2014年10月于郑州大学第一附属医院及郑州市金水区总医院就诊的高血压性TH破入脑室伴不同程度急性梗阻性脑积水患者,共计60例,随机分为2组观察组(30例),对照组(30例)。所有患者均常规给予降低颅内压、营养脑细胞、控制血压、纠正电解质紊乱及酸碱失衡、减轻脑缺氧及CO2蓄积、脑水肿及各种合并症等对症支持治疗,同时完善相关检查,做好术前准备工作。对照组采用单纯侧脑室穿刺置管引流术,观察组采用神经内镜下血肿清除术。于术后第1 d、7 d、14 d、21 d分别复查两组患者的头颅CT,判断脑室内出血的消散时间,并观察术后颅内再出血、交通性脑积水、消化道出血、颅内感染、等并发症的发生情况及拔脑室引流管时间及平均住院天数。术后常规随访患者至患者死亡或满6月为止,临床疗效的评价按日常生活能力分级法(ADL)进行,其中术后恢复良好包括ADLⅠ~Ⅲ级,疗效较差者为ADLⅣ~Ⅴ级。收集数据,并进行统计分析。结果60例入选患者的临床特征与手术相关变量是相吻合的。观察组患者年龄56.0±5.6岁,出血量31.0±15.6 ml,手术距发病时间10.8±3.2 h,GCS评分9.6±3.0;对照组年龄56.0±5.9岁,出血量31.6±17.2 ml,手术距发病时间10.2±3.6 h,GCS评分10.1±3.4。两组患者间的术前一般资料无显著差异(p0.05)。观察组有2例患者死亡,病死率6.7%,恢复良好率73.3%;对照组有5例患者死亡,病死率16.7%,恢复良好率43.3%。观察组与对照组患者的恢复良好率比较,差异有统计学意义(χ2=4.39,p=0.04)。观察组术后存活患者28例,脑室血肿消散时间≤7 d者23例,所占比率为82.1%,明显高于对照组(52.0%),差异有统计学意义(χ2=5.51,p0.01)。观察组交通性脑积水患者1例(3.3%),较对照组(16.7%)的发生率明显更低,且两组间发生率差异显著(p0.01,χ2=15.15)。观察组颅内感染患者3例(10.0%),发生率明显低于对照组(23.3%),观察组消化道出血患者3例(6.67%)、术后颅内再出血患者1例(3.33%),与对照组相比较,其发生率差异均无统计学意义(p0.05)。结论神经内镜下血肿清除既能及时解除急性梗阻性脑积水降低颅内压,又可以处理丘脑血肿,能彻底治疗由三脑室受压引起的脑脊液循环障碍,而且在治疗效果上明显优于单纯行侧脑室穿刺引流术,很少出现并发症。其在高血压性TH破入脑室合并梗阻性脑积水治疗方面取得了良好的疗效,是该类患者的首选手术方案,可进一步推广应用于临床实践。
[Abstract]:Objective to observe the clinical effect of simple lateral ventricular puncture catheter drainage and endoscopic hematoma removal in the treatment of hypertensive TH with acute supratentorial obstructive hydrocephalus. To provide the basis of choice for the clinical treatment of hypertensive patients with acute obstructive hydrocephalus after TH breaking into the ventricle. Methods in full accordance with the inclusion and exclusion criteria and with retrospective investigations, From January 2010 to October 2014, 60 patients with acute obstructive hydrocephalus and hypertensive TH broken into the ventricle were selected from the first affiliated Hospital of Zhengzhou University and General Hospital of Jinshui District of Zhengzhou City. They were randomly divided into two groups: observation group (30 cases) and control group (30 cases). All the patients were given routine treatment of lowering intracranial pressure, nourishing brain cells, controlling blood pressure, correcting electrolyte disturbance and acid-base imbalance, reducing cerebral hypoxia and CO2 accumulation, brain edema and various complications, and improving relevant examination. Prepare for the operation. The control group was treated with simple lateral ventricular puncture and drainage, and the observation group with neuroendoscope hematoma clearance. The brain CT, of the two groups were examined on the 1st day, 7th day, 14th day and 21st day, respectively, to determine the time of dissipation of intraventricular hemorrhage, and to observe the postoperative intracranial rebleeding, communicating hydrocephalus, gastrointestinal hemorrhage and intracranial infection. The occurrence of the complications, the time of pulling out the ventricular drainage tube and the average length of hospitalization. The clinical efficacy was evaluated according to the activity of daily living (ADL) classification (ADL). The postoperative recovery included ADL 鈪，

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