目的：比较开颅血肿清除去骨瓣减压术与微创钻孔引流联合尿激酶溶解术对高血压脑出血患者颅内压的影响。方法选取2012年2月—2014年7月贵阳市第一人民医院收治的高血压脑出血患者86例，按照手术方法分为开颅组44例与引流组42例。开颅组患者行开颅血肿清除去骨瓣减压术，引流组患者行微创钻孔引流联合尿激酶溶解术。比较两组患者手术时间、术中出血量、术后1~7 d 颅内压、术前及术后1~7 d 甘露醇用量、术后3个月病死率及日常生活活动能力（ADL）评分。结果引流组患者手术时间短于开颅组，术中出血量少于开颅组（P ﹤0.05）。时间与方法在颅内压上存在交互作用（P ﹤0.05）；时间在颅内压上主效应显著（P ﹤0.05）；方法在颅内压上主效应不显著（P ﹥0.05）；引流组患者术后1、2 d 颅内压高于开颅组，术后3~7 d 颅内压低于开颅组（P ﹤0.05）。时间与方法在甘露醇用量上存在交互作用（P ﹤0.05）；时间在甘露醇用量上主效应显著（P ﹤0.05）；方法在甘露醇用量上主效应不显著（P ﹥0.05）；引流组患者术后4~7 d 甘露醇用量少于开颅组（ P ﹤0.05）。两组患者病死率、ADL 评分比较，差异无统计学意义（P ﹥0.05）。结论微创钻孔引流联合尿激酶溶解术对高血压脑出血患者颅内压的降低效果优于开颅血肿清除去骨瓣减压术，有助于缩短患者手术时间，减少患者术中出血量。%Objective To compare the impact on intracranial pressure of patients with hypertensive cerebral hemorrhage between craniotomy for hematoma clearance combined with decompressive craniectomy and minimally invasive drilling drainage combined with urokinase dissolve surgery. Methods A total of 86 patients with hypertensive cerebral hemorrhage were selected in the First Hospital of Guiyang from February 2012 to July 2014,and they were divided into A group(n = 44)and B group(n = 42)according to surgical procedures. Patients of A group received craniotomy for hematoma clearance combined with decompressive craniectomy,while patients of B group received minimally invasive drilling drainage combined with urokinase dissolve surgery. Duration of surgery,intraoperative blood loss,intracranial pressure within 1 to 7 days after surgery,mannitol dosage before surgery and within 1 to 7 days after surgery,fatality rate within 3 months after surgery and ADL score after 3 months of surgery were compared between the two groups. Results Duration of surgery of B group was statistically significantly shorter than that of A group,and intraoperative blood loss of B group was statistically significantly less than that of A group(P ﹤ 0. 05). There was interaction between time and method in intracranial pressure;the main effect of time was significant in intracranial pressure(P ﹤ 0. 05),but that of method was not significant( P ﹥ 0. 05);after 1 day and 2 days of surgery,intracranial pressure of B group was statistically significantly higher than that of A group,respectively,while intracranial pressure of B group was statistically significantly lower than that of A group within 3 to 7 days after surgery,respectively(P ﹤ 0. 05). There was interaction between time and method in mannitol dosage(P ﹤ 0. 05);the main effect of time was significant in mannitol dosage (P ﹤ 0. 05),but that of method was not significant(P ﹥ 0. 05);mannitol dosage of B group was statistically significantly less than that of A group within 4 to 7 days after surgery(P ﹤ 0. 05). No statistically significant differences of fatality rate within 3 months after surgery or ADL score after 3 months of surgery was found between the two groups( P ﹥ 0. 05). Conclusion Minimally invasive drilling drainage combined with urokinase dissolve surgery has better effect in reducing the intracranial pressure of patients with hypertensive cerebral hemorrhage than craniotomy for hematoma clearance combined with decompressive craniectomy,is helpful to shorten the duration of surgery and reduce the intraoperative blood loss.
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