开颅术与钻孔引流术对中年高血压性脑出血患者颅内压的影响

摘要

Objective To compare the difference of intracranial pressure (ICP) between two surgical procedures, traditional craniotomy and puncture drainage in patients with mid-life hypertensive intracerebral hemorrhage. Methods One hundred and twelve cases with mid-life hypertensive intracerebral hemorrhage were randomly divided into two groups. In one group (60 cases) the patients had traditional craniotomy and another group (52 cases) had puncture drainage. ICP was monitored by placing catheter in lateral ventricle on the contralateral side of the hemorrhage. ICP values were collected after operation, 24 h, 72 h and 1 week later. Results Although all the patients showed increased ICP, patients in traditional craniotomy group had lower ICP values than patient in puncture drainage group[after operation, 24 h, 72 h and 1 week was(2.03 ± 1.29)mm Hg vs (4.57 ± 1.36)mm Hg,(3.12 ±1.32)mm Hgvs (4.98 ± 1.49)mm Hg,(3.81 ± 1.57)mm Hg vs (5.26 ± 1.84)mm Hg,(2.78 ±1.65)mm Hg vs (3.79 ±1.90)mm Hg, respectively](P＜0.01). Conclusion Traditional craniotomy has advantages over puncture drainage for patients with mid-life hypertensive intracerebral hemorrhage with respect to decreasing ICP.%目的 探讨传统开颅与钻孔引流及尿激酶溶解术两种治疗方式对中年高血压性脑出血患者颅内压的影响。方法 将112例中年高血压性脑出血患者完全随机分为2组，分别采用开颅术（60例，开颅组）和钻孔引流及尿激酶溶解术（52例，钻孔组）治疗，同时在出血对侧行侧脑室置管，进行侧脑室颅内压监测。采集术后即刻、24、72 h及1周的颅内压值，进行统计分析。结果 开颅组与钻孔组术后ICP均有增高，但开颅组颅内压明显低于钻孔组，差异有统计学意义[术后即刻、24、72h及1周分别为(2.03±1.29)mm Hg比(4.57±1.36) mm Hg、(3.12±1.32)mm Hg比(4.98±1.49)mm Hg、(3.81±1.57) mm Hg比(5.26±1.84)mm Hg、(2.78±1.65 )mm Hg比(3.79±1.90)mm Hg，P＜0.01]。结论 在降低颅内压力方面传统开颅术明显优于钻孔引流及尿激酶溶解术。