摘要:
目的 比较钻孔引流术与开颅血肿清除术治疗中等量高血压脑出血(HICH)的疗效与安全性.方法 将阳煤集团总医院2015年8月至2018年8月收治的56例中等量HICH患者随机分为钻孔组与开颅组,每组28例.比较两组患者术后动态颅内压变化、手术时间、术后恢复情况、术后并发症、神经功能功能及日常生活能力等指标.结果 两组颅内压水平在术后即刻至术后48 h呈上升趋势,在术后48 h至术后7 d呈下降趋势,但钻孔组上升及下降幅度均小于开颅组,差异有统计学意义(P<0.05);开颅组术后即刻及术后24、48 h颅内压水平均低于钻孔组(P<0.05).钻孔组手术时间、意识恢复时间、下床活动时间及术后住院时间均少于开颅组(P均<0.05);钻孔组术后并发症发生率低于开颅组(P<0.05).与术前比较,两组患者术后14 d神经功能缺损(肢体肌力与语言能力方面)评分均降低(P<0.05),术后3个月日常生活能力(ADL)评分均提高;钻孔组术后14 d神经功能缺损(肢体肌力与语言能力方面)评分低于开颅组(P<0.05),术后3个月ADL评分高于开颅组(P<0.05).结论 相较于开颅血肿清除术,中等量HICH患者可选择钻孔引流术治疗,能够在更短时间内获得更好的手术效果与预后效果,降低并发症风险,安全有效.%Objective To compare the efficacy and safety of burr holes irrigation and drainage ( BHID) and craniotomy evacuation of hematoma in the treatment of moderate amount of hypertensive intracerebral hemorrhage ( HICH ) .Methods Fifty-six patients with moderate amount of HICH hospitalized in Yangmei Group General Hospital from August 2015 to August 2018 were randomly divided into trepanation group and craniotomy group , with 28 cases in each group .The dynamic intracranial pressure changes , operative time , postoperative recovery , postoperative complications , neurological function and activity of daily living ( ADL ) were compared between the two groups .Results The intracranial pressure levels in the two groups were increased immediately after operation until 48 h after operation, and then the intracranial pressure decreased 48 h after operation until 7 d after operation, but the increase and decrease in trepanation group were smaller than those in craniotomy group ( P<0.05 ) . The intracranial pressure in craniotomy group was significantly lower than that in trepanation group immediately after operation and at 24 h and 48 h after operation ( P<0.05 ) .The operative time , consciousness recovery time , ambulation time and postoperative hospital stay in trepanation group were significantly shorter than those in craniotomy group ( P<0.05 ) . The incidence of postoperative complications in trepanation group was significantly lower than that in craniotomy group ( P<0.05 ) . Compared with preoperative scores , the scores of neurological deficit ( limb muscle strength and language ability) in the two groups were significantly decreased 14 d after operation (P<0.05), and the ADL scores were significantly improved 3 months after operation . The neurological deficit ( limb muscle strength and language ability ) scores in trepanation group were significantly lower than those in craniotomy group 14 d after operation ( P<0.05 ) , and the ADL score in trepanation group was significantly higher than that in craniotomy group 3 months after operation ( P<0.05 ) . Conclusions Compared with craniotomy evacuation of hematoma , BHID can achieve better surgical results and prognosis effects in a shorter time and reduce risk of complication for patients with moderate amount of HICH , which is safe and effective .