本文選題：高血壓病 + 小腦出血��； 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:高血壓小腦出血是臨床上常見的腦血管疾病,其發(fā)病快,病情兇險(xiǎn),故病死率、致殘率極高,內(nèi)科保守治療效果差,應(yīng)用適當(dāng)?shù)耐饪浦委熓侄慰山档突颊叩乃劳雎始爸職埪?本課題通過比較、分析CT輔助定向軟通道穿刺術(shù)與后顱窩開顱血腫清除術(shù),兩種不同術(shù)式治療高血壓小腦出血的臨床療效,并發(fā)癥及預(yù)后情況,以希望為高血壓小腦出血的外科治療提供一定的幫助。方法:回顧并分析我院自2008年01月--2014年06月收治的經(jīng)CT輔助定向軟通道穿刺術(shù)與開顱血腫清除術(shù),兩種不同術(shù)式治療高血壓小腦出血臨床資料,合計(jì)40例,將患者分為兩組,穿刺組(給予CT輔助定向軟通道穿刺術(shù))共12例和手術(shù)組(給予后顱窩開顱血腫清除術(shù))共28例,對(duì)兩組患者手術(shù)時(shí)間、血腫清除率、術(shù)后再出血率、肺部感染、皮下積液、術(shù)后腦積水等臨床進(jìn)行分析比較,應(yīng)用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行處理并分析,計(jì)量資料的統(tǒng)計(jì)描述懫取均數(shù)±標(biāo)準(zhǔn)差(sx±)表示,兩組間的比較采用t檢驗(yàn),計(jì)數(shù)資料的統(tǒng)計(jì)描述采取率或構(gòu)成比,組間比較采用卡方檢驗(yàn)進(jìn)行分析,確定檢驗(yàn)水準(zhǔn)a=0.05。P0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)兩組患者術(shù)前臨床特征方面,年齡:穿刺組60.92±7.98;手術(shù)組57.33±6.73P=0.169。性別:穿刺組男性8例占66.70%女性4例占33.30%;手術(shù)組男性17例占60.71%女性11例占39.30%;P=1.00。術(shù)前GCS評(píng)分穿刺組8.92±2.43手術(shù)組9.22±2.21 P=0.715。術(shù)前出血量穿刺組17.64±3.33手術(shù)組19.41±3.74P=0.178;差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)術(shù)后兩組患者手術(shù)時(shí)間的比較,穿刺組55.58±8.37分,手術(shù)組208.61±25.94分P0.01;術(shù)后GOS評(píng)分,穿刺組4-5分8例占66.67%,手術(shù)組4-5分9例32.10%P=0.043;術(shù)后患者血腫清除率(3天內(nèi)拔管時(shí))的比較,穿刺組90%以上8例占66.67%,80-90%1例占8.33%,手術(shù)組90%以上10例占35.71%,80-90%17例占60.71%,P=0.004;P值均0.05,差異均有統(tǒng)計(jì)學(xué)意義。術(shù)后再出血率的比較,穿刺組1例占9.09%,手術(shù)組3例占10.71%P=0.430 P0.05,差異無統(tǒng)計(jì)學(xué)意義。(3)肺部感染發(fā)生率的比較,穿刺組2例16.67%,手術(shù)組15例53.57%P=0.030;術(shù)后顱內(nèi)感染生率的比較,穿刺組無顱內(nèi)感染,手術(shù)組8例28.57%P=0.038;皮下積液發(fā)生率比較,穿刺組無,手術(shù)組10例占35.71%P=0.046;P值均0.05,差異均有統(tǒng)計(jì)學(xué)意義。術(shù)后腦積水發(fā)生率比較,穿刺組3例占25.00%手術(shù)組:9例占32.14%P=0.946 P0.05,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:CT輔助定向軟通道穿刺術(shù)治療高血壓小腦出血縮短了手術(shù)耗時(shí),為危重患者的搶救贏得了寶貴的時(shí)間,手術(shù)創(chuàng)傷小,操作簡單,減少了并發(fā)癥,拓寬了手術(shù)適應(yīng)證,提高患者生存質(zhì)量,降低死亡率。是治療小腦出血快速、簡便、有效的方法,值得在臨床上推廣。
[Abstract]:Objective: hypertensive cerebellar hemorrhage is a common cerebrovascular disease in clinic. Proper surgical treatment can reduce the mortality and disability rate of the patients. Through comparison, this paper analyzes the CT assisted directional soft channel puncture and the posterior craniotomy hematoma removal. The clinical efficacy, complications and prognosis of two different surgical procedures for hypertensive cerebellar hemorrhage were discussed in order to provide some help for the surgical treatment of hypertensive cerebellar hemorrhage. Methods: the clinical data of 40 patients with hypertensive cerebellar hemorrhage treated by CT-assisted directional soft channel puncture and craniotomy were retrospectively reviewed and analyzed from January 2008 to June 2014. The patients were divided into two groups. There were 12 cases in the puncture group and 28 cases in the operation group. The operation time, hematoma clearance rate, postoperative rebleeding rate, pulmonary infection, subcutaneous effusion were compared between the two groups. Postoperative hydrocephalus and other clinical data were analyzed and compared. SPSS 13.0 statistical software was used to process and analyze. The statistical description of measurement data was expressed by mean 鹵standard deviation (sx 鹵), and the comparison between the two groups was performed by t test. The statistical description rate or composition ratio of counting data was analyzed by chi-square test to determine the test level (a0.05.05). Results in terms of preoperative clinical features, age: puncture group (60.92 鹵7.98), operation group (57.33 鹵6.73Pl) 0.169. Sex: in the puncture group, there were 8 males (66.70%), 4 females (33.30%) and 17 males (60.71%) in the operation group (11 cases) (39.30%). The preoperative GCS score was 8.92 鹵2.43 in the puncture group and 9.22 鹵2.21 in the operative group. The operative time of the two groups was 55.58 鹵8.37 in the puncture group, 208.61 鹵25.94 in the operation group, and 208.61 鹵25.94 in the operation group (P 0.01). In the puncture group (4-5 points, 8 cases, 66.67%), the operation group (4-5 points, 9 cases, 32.10P0. 043; the postoperative hematoma clearance rate, extubation within 3 days), the puncture group (more than 90%) accounted for over 8 cases (66.67%, 80-901 cases, 8.33%), the operation group, more than 90% (10 cases, 35.71%, 80-90 cases, 60.71P = 0.004 P, 0.05), the difference was statistically significant. The rate of postoperative rebleeding was 9.09 in the puncture group and 10.71 in the operation group. There was no significant difference in the incidence of pulmonary infection between the puncture group (n = 2) and the operation group (n = 15). The incidence of intracranial infection was compared between the puncture group (n = 2) and the operation group (n = 15). There was no intracranial infection in the puncture group, and the incidence of subcutaneous effusion in the operation group was 28.57 and 0.038, but there was no subcutaneous effusion in the puncture group (P = 35.71, P = 0.046, P = 0.05, respectively), and the difference was statistically significant. The incidence of hydrocephalus after operation was 25.00% in the puncture group, 9 cases in the operation group and 32.14 P0.946 P0.05in the puncture group, the difference was not statistically significant. Conclusion the operation time is shortened and the time is gained for the treatment of hypertensive cerebellar hemorrhage by the use of soft channel puncture assisted with the use of the special soft channel. The surgical trauma is small, the operation is simple, the complications are reduced, and the indication of the operation is widened. Improve patients' quality of life and reduce mortality. It is a rapid, simple and effective method for the treatment of cerebellar hemorrhage.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.12

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