钻孔引流术结合尿激酶溶解对高血压脑出血患者术后颅内压的影响

摘要

目的 探讨钻孔引流术结合尿激酶溶解对高血压脑出血患者术后颅内压的影响.方法 选择在本院治疗的86例高血压脑出血患者作为研究对象,根据手术方法的不同将其分为观察组(钻孔引流术结合尿激酶溶解)与对照组(传统开颅术),每组43例.分别于术后即时、术后1d、术后3d、术后1周,采用惠普V24型多导生理监护仪监测患者颅内压变化情况,记录术后并发症,并进行对比.结果 两组颅内压水平均从术后即时开始增高,术后3d达到峰值,术后1周出现下降,观察组不同时间段颅内压水平均明显高于对照组,差异均有统计学意义(均P＜ 0.05);观察组术后感染发生率低于对照组(2.33％比18.60％),而术后再出血率高于对照组(23.26％比4.65％),差异均有统计学意义(均P＜0.05).结论 高血压脑出血采用开颅手术治疗有利于降低颅内压,减少脑组织损伤,但该术式创伤大,钻孔引流术结合尿激酶溶解治疗操作简单、对患者的创伤较小,因此在临床应用中应结合患者实际病情、出血部位、血肿量等多方因素,合理选择手术方法.%Objective To explore the effect of trepanation and drainage combining urokinase dissolution on postoperative intracranial pressure in patients with hypertensive cerebral hemorrhage.Methods 86 patients with hypertensive cerebral hemorrhage treated at our hospital were selected as research objects and were divided into an observation group,treated by trepanation and drainage combining urokinase dissolution,and a control group,conventional craniotomy,according to different surgical methods,43 for each group.The changes of intracranial pressure were monitored by HP V24 type multi physiological monitor immediately,1 d,3 d,and 1 week after the operation.And the postoperative complications were recorded and compared.Results The intracranial pressure increased immediately after the operation and to the peak 3 days after the operation and went down 1 week after the operation.The intracranial pressure was higher in the observation group than in the control group all the time,with statistical differences (all P ＜ 0.05).The incidence of postoperative infection was lower and the postoperative re-bleeding rate was higher in the observation group than in control group (P ＜ 0.05).Conclusion Craniotomy treatment for hypertensive cerebral hemorrhage is beneficial in reducing intracranial pressure and brain damage,but with great surgical trauma.Trepanation and drainage combining urokinase dissolution for hypertensive cerebral hemorrhage is easy to operate actual conditions,bleeding site,hematoma volume,and other factors.