目的 探讨治疗老年高血压脑大量出血的适宜方法。方法 回顾性分析老年高血压脑大量出血患者112例，分为传统骨瓣开颅组和钻孔引流手术组，对两组患者术后7 d神志转清比率、术后再出血发生率、术后2周并发症(肺部感染)发生率、住院期间病死率、术后30 d改良Rankin量表评分(modified rankin scale，MRS)及术后3个月MRS评分进行比较。结果 钻孔引流手术组和传统骨瓣开颅组7 d内意识恢复率分别为74.07%和43.10%，2周内肺部感染发生率分别为9.26%和25.86%，术后气管切开比率分别为3.70%和10.34%，钻孔引流手术组明显优于骨瓣开颅组，差异均有统计学意义(P<0.05)，两组患者术后30 dMRS评分(χ2＝18.907，P＝0.002)及出院后3个月随访MRS评分(χ2＝12.642，P＝0.027)，钻孔引流手术组与骨瓣开颅组相比，差异有统计学意义(P＜0.05)。结论 钻孔穿刺引流术是一种相对简单有效的方法，对脑组织的损伤较小，术后并发症少，术后患者意识恢复更快，有助于患者的早期康复，是此类患者的首选治疗方法。
Abstract
Objective To find a suitable method for the treatment of large area hypertensive cerebral hemorrhage in the elderly.Methods Retrospective analysis was made of 112 elderly patients with large area hypertensive cerebral hemorrhage. Treatment of traditional bone flap craniotomy and drilling drainage were used. The rates of consciousness recovery in a week after the operation, the rates of postoperative bleeding again, the rates of postoperative complications(pulmonary infection) in two weeks, in-hospital mortality, MRS(Modified Rankin Scale) scores at 30 days after surgery, MRS scores at 3 months after surgery for the two groups were measured and compared.Results The rates of consciousness recovery in a week after the operation were 74.07% and 43.10%, the rates of pulmonary infection in two weeks were 9.26% and 25.86%,and the rates of tracheotomy after the operation were 3.70% and 10.34%,with significant difference(P<0.05), patients with drilling drainage were much better than the patients with traditional bone flap craniotomy. There were significant differences in the MRS scores at 30 days after surgery(χ2＝18.907,P＝0.002) and MRS scores at 3 months after surgery(χ2＝12.642,P＝0.027), patients with drilling drainage were also much better.Conclusions Drilling drainage is a simple and effective method for the treatment of hypertensive cerebral hemorrhage. It damages the brain tissue less. It reduces the incidence of postoperative complications compared with the traditional bone flap craniotomy surgery. Patients can regain consciousness early after the operation, which undoubtedly helps patients recover early. So drilling drainage is the preferred treatment for large area hypertensive cerebral hemorrhage in the elderly.
关键词
高血压脑出血 /
老年 /
大面积 /
传统开颅 /
钻孔引流术
Key words
hypertensive cerebral hemorrhage /
the elderly /
large area /
traditional bone flap craniotomy surgery /
drilling drainage
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参考文献
[1] McKissock W,Richardson A,Taylor J.Primary intracerebral haemorrhage:A controlled trial of surgical and conservative treatment in 180 unselected cases[J].Lancet,1998,2:221-226.
[2] Backlund E D,Holst V H.Controled subtotal evacuation of intracerebral hematomas by stereotactic technique[J].Surg Neurol,1978, 9(2):99-101.
[3] Prasad K, Browman G, Srivastava A, et al. Surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trials[J]. Acta Neurol Scand, 1997, 95(2):103-110.
[4] Ming Liu, Bo Wu, Wenzhi Wang, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol,2007,6: 456–464.
[5] 梁子聪,曾 松,陈 进,等.不同术式对高血压脑出血老年患者预后的影响[J].中国临床神经外科杂志,2010,15(6):372-373.
[6] 何小平,牛小亚.大量出血的老年性高血压脑出血患者微创手术治疗体会[J]. 中国临床研究, 2015, 28(4):469-471.
[7] 喇新军.老年性高血压脑出血手术治疗预后的影响因素[J].航空航天医药,2009,20(2):101-102.
[8] 肖 娟,赵建红,李连生.颅内血肿微创清除术治疗急性脑出血最佳手术时机探讨[J].河北医药,2010,32(14):1901-1902.
[9] 洁 丹,邵书梅.颅内血肿微创穿刺粉碎清除术后再出血的临床分析[J].中国实用神经疾病杂志,2008,11(2):137-138.
[10] 有 安.微创穿颅血肿清除术临床相关问题的探讨[J].中风与神经疾病杂志,2003,20(3):270-271.
[11] 杨冰霞,杨 标,郑越瑜,等.早期康复训练对脑出血偏瘫患者患肢功能及日常生活活动能力的影响[J].广东医学院学报,2009,27(3):290-291.
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