本文選題：腦出血　切入點(diǎn)：高血壓　出處：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2017年04期

【摘要】：目的探討開(kāi)顱血腫清除聯(lián)合腦室外引流和單純腦室外引流治療高血壓腦出血破入腦室的療效。方法回顧性分析2012年6月至2015年6月3年內(nèi)我院收治的70例接受手術(shù)治療的高血壓腦出血破入腦室患者的臨床資料,其中腦室外引流聯(lián)合開(kāi)顱血腫清除(EVD+HE組)患者31例,單純腦室外引流(EVD組)39例。比較兩組患者的格拉斯哥昏迷評(píng)分(GCS)、神經(jīng)外科重癥監(jiān)護(hù)室(NICU)住院天數(shù)、死亡率、肺部感染、顱內(nèi)感染和再出血的發(fā)生率以及隨訪6個(gè)月后的改良Rankin量表(mRS)評(píng)分及格拉斯哥預(yù)后評(píng)分(GOS)。然后篩選比較兩組中幕上血腫量30mL患者的上述臨床指標(biāo)。結(jié)果術(shù)后住院期間EVD+HE組9例(29.0%)患者死亡,EVD組2例(5.1%)死亡,差異有統(tǒng)計(jì)學(xué)意義(P=0.008);其余存活患者繼續(xù)納入后續(xù)研究。EVD+HE組患者GCS評(píng)分增加值(ΔGCS)大于EVD組(P0.05);兩組患者NICU住院時(shí)間,術(shù)后再出血及肺部感染、顱內(nèi)感染發(fā)生率,隨訪6個(gè)月后mRS及GOS評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。EVD+HE組幕上血腫量30mL的患者ΔGCS、術(shù)后6個(gè)月mRS及GOS評(píng)分均優(yōu)于EVD組(P0.05),但NICU住院時(shí)間、術(shù)后再出血及肺部感染、顱內(nèi)感染發(fā)生率與EVD組相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論對(duì)于幕上血腫量30mL的患者,開(kāi)顱血腫清除聯(lián)合腦室外引流術(shù)療效優(yōu)于單純腦室外引流術(shù)。
[Abstract]:Objective to evaluate the efficacy of craniotomy combined with ventricular drainage and ventricular drainage in the treatment of hypertensive intracerebral hemorrhage. Methods 70 patients with hypertensive intracerebral hemorrhage admitted to our hospital during the three years from June 2012 to June 2015 were retrospectively analyzed. Clinical data of patients with hypertensive intracerebral Hemorrhage broken into ventricle, Among them, 31 cases were treated with ventricular drainage combined with craniotomy and hematoma clearance (EVD HE group) and 39 cases with simple ventricular drainage (EVD group). The Glasgow coma score (Glasgow coma score), the days of stay in neurosurgery intensive care unit (NICU), the mortality rate, and pulmonary infection were compared between the two groups. The incidence of intracranial infection and rebleeding and the modified Rankin scale mRSs and Glasgow prognosis score were evaluated after 6 months follow up. Then the two groups of patients with supratentorial hematoma volume (30mL) were selected and compared. Results the patients were hospitalized after operation. During which 9 patients died in the EVD HE group and 2 patients died in the EVD group. The difference was statistically significant (P < 0. 008). The other surviving patients continued to be included in the follow-up study. The increased value of GCS score (螖 GCSs) in the EVD-HE group was higher than that in the EVD group (P 0.05). The duration of NICU hospitalization, postoperative rebleeding and pulmonary infection, and the incidence of intracranial infection were observed in the two groups. There was no significant difference in the scores of mRS and GOS after 6 months follow-up. There was no significant difference in 螖 GCSs between the patients with 30mL of supratentorial hematoma volume in the EVD-HE group. The scores of mRS and GOS at 6 months after operation were better than those in the EVD group (P 0.05), but the hospitalization time of NICU, postoperative rebleeding and pulmonary infection were better than those in the EVD group. There was no significant difference in the incidence of intracranial infection between the EVD group and the EVD group. Conclusion for the patients with supratentorial hematoma volume 30mL, the curative effect of craniotomy combined with ventricular drainage is better than that of simple ventricular drainage.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)征醫(yī)院神經(jīng)外科;
【基金】：國(guó)家自然科學(xué)基金(81371382) 上海市“領(lǐng)軍人才”計(jì)劃(2012049) 上海市科技人才計(jì)劃(15XD1504700)~~
【分類(lèi)號(hào)】：R544.1;R651.12
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本文編號(hào)：1691522