锥颅穿刺术与开颅手术在脑出血治疗中的应用对比

摘要

目的 评价锥颅穿刺术与开颅手术治疗脑出血的临床疗效.方法 选取2011年6月至2012年12月我院收治的58例脑出血患者,按随机数字表将其分为对照组和观察组各29例.对照组行传统小骨窗开颅血肿清除术,观察组行锥颅穿刺抽吸引流血肿清除术.观察和比较两组手术情况、术后近期格拉斯哥预后评分(GOS)以及Barthel指数评定评分.结果 在手术时间、拔管时间和住院时间上,观察组明显低于对照组,同样在复发率方面,观察组(10.34％)要低于对照组(17.24),差异具有统计学意义(P＜0.05).但在血肿清除率方面中,两组差异无统计学意义(P＞0.05);与术前比,两组术后GOS短期预后评分都有所提高,其中观察组术后GOS短期预后评分为(13.12±4.54)分,显著高于对照组(P＜0.05),术后GOS正常和轻度昏迷例数显著高于对照组(P＜0.05),而重度昏迷和死亡频数显著低于对照组(P＜0.05);同时在Barthel远期评分中观察组为(71.35±14.21)分,显著高于对照组(P＜0.05);观察组Barthel优良率达82.76％,显著高于对照组(P＜0.05).结论 锥颅穿刺抽吸引流血肿清除术具有手术时间短、操作简便等优点,能显著提高开颅手术治疗脑出血的短期和远期临床疗效,是治疗高血压脑出血的有效方法之一.%Objective To evaluate the clinical efficacy of skull puncture and craniotomy in the treatment of cerebral hemorrhage.Methods From June 2011 to December 2012 in our hospital,58 patients with cerebral hemorrhage were randomly divided into the control group and the observation group,with 29 cases in each group.The control group applied traditional small bone window hematoma evacuation,while the observation group applied skull puncture.The clinical effect,postoperative Glasgow Outcome Score (GOS) and Barthel Index score were observed and compared between the two groups.Results The operation time,time to extubation and length of hospital stay in the observation group were significantly lower than those in the control group.The recurrence rate in the observation group (10.34％) was significantly lower than that in the control group (17.24),Cerebral hemorrhage; Craniotomy;Skull puncture; Clinical efficacy＜0.05.The two groups showed no statistically significant difference in hematoma rate (P＞0.05).Compared with before treatment,postoperative GOS short-term prognostic score was improved,which was (13.12±4.54) in the observation group,significantly higher than that in the control group (P＜0.05).The cases with normal postoperative GOS and mild coma was significantly more in the observation group (P＜0.05),and the cases of severe coma and death frequency was significantly lower than those in the control group (P＜0.05).At the same time,the Barthel forward score in the observation group [(71.35±14.21)] was significantly higher than that in the control group (P＜0.05).The Barthel excellent rate of the observation group was 82.76％,significantly higher than that of the control group (P＜0.05).Conclusion Drawing hematoma through skull puncture has the advantages of shorter operation time,easy to operate,and can significantly improve the short-term and long-term clinical efficacy of craniotomy cerebral hemorrhage,which is one of the effective methods for the treatment of hypertensive intracerebral hemorrhage.