微创穿刺引流术治疗高血压脑出血临床疗效观察

发布时间：2019-03-21 12:38

【摘要】：目的:探讨微创穿刺引流术治疗高血压脑出血的临床疗效。本研究拟通过比较微创穿刺引流术与开颅手术治疗高血压脑出血的临床疗效,探讨微创穿刺引流术治疗高血压脑出血的临床优势,以便更好的指导临床治疗。方法:选取山西医科大学第一临床医学院2013年10月-2014年12月收治的72例HICH患者,全部患者经头颅CT扫描后诊断,诊断标准符合第四届脑血管学术会议关于高血压脑出血标准。随机将72例患者分为观察组与对照组两组,两组患者在年龄、性别、出血部位、出血量、术前GCS评分及发病至手术时间等方面相比较,差异无统计学意义(P0.05),两组资料具有可比性。观察组采用微创穿刺引流术进行治疗,对照组采用开颅手术,比较两组的手术时间、术中出血量、治疗有效率、术后恢复情况及并发症发生情况。结果:(1)观察组平均手术时间为(46.54±6.36)min,手术中平均出血量为(90.50±22.06)ml。对照组平均手术时间为(100.62±8.54)min,手术中平均出血量为(320.20±35.15)ml。两组相比较,观察组手术时间及术中出血量明显少于对照组,差异有统计学意义(P0.05)。(2)经治疗后,观察组治疗有效患者33例,治疗总有效率为91.67%。对照组治疗有效患者为26例,治疗总有效率为72.22%,两组相比较,观察组治疗总有效率明显优于对照组,差异有统计学意义(P0.05)。(3)两组患者全部随访6个月,分别进行ADL评分评价远期疗效,以(I+II+III)级为恢复良好率,两组相比较,观察组明显优于对照组,差异有统计学意义(P0.05)。(4)两组患者术后并发症情况进行统计,微创穿引流术后并发症发生率为11.11%。开颅术后并发症发生率为33.33%。两组相比较,观察组术后并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论:(1)观察组与对照组相比,微创穿刺引流术手术时间明显少于开颅手术组,微创穿刺引流组术中出血量明显少于开颅手术组。(2)观察组与对照组相比较,微创穿引流术治疗组治疗总有效率优于开颅手术组。(3)全部患者经6个月随访,微创穿刺引流组远期疗效评价优于开颅手术组。(4)并发症统计方面,微创穿刺引流组术后并发症明显少于开颅手术组。
[Abstract]:Objective: to investigate the clinical effect of minimally invasive puncture and drainage for hypertensive intracerebral hemorrhage. The purpose of this study was to compare the clinical efficacy of minimally invasive puncture drainage and craniotomy in the treatment of hypertensive intracerebral hemorrhage and to explore the clinical advantages of minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage in order to better guide the clinical treatment of hypertensive intracerebral hemorrhage. Methods: 72 patients with HICH were selected from October 2013 to December 2014 in the first Clinical Medical College of Shanxi Medical University. All the patients were diagnosed after brain CT scan. The diagnostic criteria met the criteria of the fourth Cerebrovascular academic Conference on hypertensive intracerebral hemorrhage. 72 patients were randomly divided into two groups: observation group and control group. There was no significant difference in age, sex, bleeding site, bleeding volume, preoperative GCS score and time from onset to operation between the two groups (P0.05). The two sets of data are comparable. The observation group was treated with minimally invasive puncture and drainage, and the control group was treated with craniotomy. The operative time, intraoperative blood loss, effective rate of treatment, postoperative recovery and complications were compared between the two groups. Results: (1) the average operative time in the observation group was (46.54 卤6.36) min,. The average blood loss in the operation was (90.50 卤22.06) ml.. The average operative time in the control group was (100.62 卤8.54) min,. The average blood loss in the operation was (320.20 卤35.15) ml.. Compared with the two groups, the operative time and bleeding volume in the observation group were significantly less than those in the control group (P0.05). (2). After treatment, 33 effective patients in the observation group were treated with a total effective rate of 91.67%. The total effective rate of the two groups was 72.22%. Compared with the two groups, the total effective rate of the observation group was obviously better than that of the control group, the difference was statistically significant (P0.05). (3), all the patients in the two groups were followed up for 6 months. ADL scores were used to evaluate the long-term curative effect. (III) grade was used as the recovery rate. Compared with the two groups, the observation group was obviously superior to the control group. The difference was statistically significant (P0.05). (4). The incidence of complications after minimally invasive drainage was 11.11%. The incidence of complications after craniotomy was 33.33%. Compared with the two groups, the incidence of postoperative complications in the observation group was significantly lower than that in the control group, the difference was statistically significant (P0.05). Conclusion: (1) compared with the control group, the operation time of minimally invasive puncture drainage in the observation group was significantly shorter than that in the craniotomy group, and the amount of bleeding in the minimally invasive puncture drainage group was significantly less than that in the craniotomy group. (2) the observation group was compared with the control group. The total effective rate of minimally invasive puncture drainage group was better than that of craniotomy group. (3) after 6 months follow-up, the long-term curative effect of minimally invasive puncture drainage group was better than that of craniotomy group. (4) the statistics of complications. The postoperative complications in the minimally invasive puncture drainage group were significantly less than those in the craniotomy group.
【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】：R651.1

【参考文献】