本文選題：高血壓腦出血 + 手術(shù)方式��； 參考：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的分析已有的臨床資料比較小骨瓣血腫清除術(shù)與穿刺引流術(shù)外科治療高血壓腦出血術(shù)式選擇及術(shù)后日常生活能力是否有更好的療效。方法對我院2013年7月至2015年3月66例小骨瓣血腫清除術(shù)與穿刺引流術(shù)高血壓腦出血患者資料進行回顧性分析。針對患者GCS評分、出血部位、出血量及不同術(shù)式的關(guān)系進行統(tǒng)計學(xué)分析,比較術(shù)后患者預(yù)后情況。結(jié)果66例患者中采用小骨瓣開顱血腫清除術(shù)共47例。術(shù)前GCS評分8分以上46例,(約97.9%),GCS8分以下1例(2.1%)；基底節(jié)區(qū)出血31例,占65.9%,丘腦出血6例,占12.7%,小腦出血4例,占8.5%,皮層出血6例,12.8%：60～80m1占8例(17.0%),40-60m1占34例(72.3%),40m1占5例(10.6%)。采用穿刺引流術(shù)患者共19例。術(shù)前GCS評分13分以上占17例(89.5%),GCS9～12分占2例(10.5%)；丘腦出血并破入腦室8例,占42.1%,腦室出血11例占57.9%,60-80m1占1例(5.2%),40-60m1占16例(84.2%),40m1占2例(10.5%)。應(yīng)用x2檢驗及spearman檢驗提示出血量、手術(shù)術(shù)式及出血部位具有明顯相關(guān)性(p0,05)。術(shù)后6月對患者進行隨訪,針對預(yù)后ADL進行相關(guān)評分,穿刺引流術(shù)優(yōu)于小骨瓣血腫清除術(shù),死亡率小骨瓣血腫清除術(shù)優(yōu)于穿刺引流術(shù)。結(jié)論患者預(yù)后均和術(shù)前GCS評分、出血部位、出血量密切相關(guān)。同時手術(shù)方式選擇及手術(shù)時機的選擇也嚴重影響患者預(yù)后的生活質(zhì)量。目的分析已有的臨床對照試驗資料比較小骨瓣血腫清除術(shù)與穿刺引流術(shù)外科治療高血壓腦出血對術(shù)后日常生活能力是否有更好的療效。方法按照系統(tǒng)評價的要求全面檢索PubMed、Medline數(shù)據(jù)庫、OVID、萬方全文數(shù)據(jù)庫、CNKI數(shù)據(jù)庫、維普中文科技期刊數(shù)據(jù)庫、CBM disk數(shù)據(jù)庫、SCIENCEDIRECT數(shù)據(jù)庫等。納入所有小骨瓣開顱血腫清除術(shù)與穿刺引流術(shù)治療高血壓腦出血的隨機對照試驗,共納入20個樣本隨機對照組,共計病例數(shù)4752例,對文獻資料進行提取并進行質(zhì)量評價。使用RevMan5.3對相關(guān)數(shù)據(jù)進行系統(tǒng)評價,使用Meta分析兩種手術(shù)病死率及預(yù)后。結(jié)果Meta分析提示：1、超早期行手術(shù)治療的高血壓腦出血患者死亡率[P=0.02,OR合并=I.37,95%CI(0.29,6.59)],無統(tǒng)計學(xué)差異(P0.05)；2、術(shù)后6個月內(nèi)日常生活能力(ADLI-Ⅲ級)。血腫穿刺引流術(shù)組優(yōu)于小骨瓣血腫清除術(shù)組,[P=-0.25,OR-=2.47,95%CI(0.38,0.88)],P0.05,有統(tǒng)計學(xué)差異；3、死亡率：小骨瓣血腫清除術(shù)低于穿刺外引流術(shù)[P=0.24,0R合并=0.81,95%CI(0.66-0.98)],P0.05,有統(tǒng)計學(xué)差異；4、再出血率：穿刺外引流術(shù)與小骨瓣血腫清除術(shù)再出血率[P=0.27,OR合并=1.41,95%CI(0.76-2.61)],P0.05,無統(tǒng)計學(xué)差異：5、肺部感染率：小骨瓣血腫清除術(shù)高于穿刺外引流術(shù)[P=0.002,0R臺并=1.8,95%CI(1.25-2.58)],P0.05,有統(tǒng)計學(xué)差異；6、消化道出血率：小骨瓣血腫清除術(shù)與穿刺外引流術(shù)消化道出血率[P=0.16,OR并-=1.44,95%CI(0.87-2.38)],P0.05,無統(tǒng)計學(xué)差異；7、尿路感染率：小骨瓣血腫清除術(shù)與穿刺外引流術(shù)尿路感染率[P=1.04,OR-=I.04,95%CI(0.55-1.99)],P0.05,無統(tǒng)計學(xué)差異；結(jié)論(1)、超早期手術(shù)治療高血壓腦出血總體死亡率,兩種手術(shù)方式死亡率基本相同,無統(tǒng)計學(xué)差異。(2)、術(shù)后6個月內(nèi)日常生活能力(ADLⅠ-Ⅲ級),血腫穿刺引流術(shù)優(yōu)于小骨瓣血腫清除術(shù)。(3)、小骨瓣血腫清除術(shù)外科治療高血壓腦出血死亡率低于穿刺引流術(shù)。(4)、小骨瓣血腫清除術(shù)與穿刺引流術(shù)治療高血壓腦出血術(shù)后再出血率基本相同,無統(tǒng)計學(xué)差異。(5)、小骨瓣血腫清除術(shù)與穿刺引流術(shù)治療高血壓腦出血術(shù)后并發(fā)癥中,肺部感染率穿刺引流術(shù)低于小骨瓣血腫清除術(shù)；消化道出血及尿路感染兩種術(shù)式基本相同,無統(tǒng)計學(xué)差異。
[Abstract]:Objective to compare the existing clinical data to compare the surgical treatment of hypertensive intracerebral hemorrhage by small flap hematoma removal and puncture drainage and the better curative effect of postoperative daily living ability. Methods 66 cases of small bone flap hematoma clearance and puncture drainage of hypertensive cerebral hemorrhage from July 2013 to March 2015 in our hospital were carried out. Retrospective analysis. According to the GCS score, bleeding site, bleeding volume and the relationship between different surgical procedures, the prognosis of postoperative patients was compared. Results of the 66 patients, small bone flap craniotomy and hematoma removal were used in 47 cases. The preoperative GCS score was 8 or more, 46 cases (about 97.9%), 1 cases (2.1%) below GCS8, 31 in basal ganglia, 65. .9%, 6 cases of thalamic hemorrhage, 12.7%, 4 cases of cerebellar hemorrhage, 8.5% of cerebral hemorrhage, 6 cases of cortical hemorrhage, 8 cases (17%), 40-60m1 in 34 cases (72.3%), 5 cases (10.6%) with 40m1 and 5 cases (5 cases). The preoperative GCS score in 4 or more cases, GCS9 to the ventricle, cerebral hemorrhage and cerebral ventriculus 11 cases of ventricular hemorrhage accounted for 57.9%, 60-80m1 accounted for 1 cases (5.2%), 40-60m1 accounted for 16 cases (84.2%), and 40m1 accounted for 2 cases (10.5%). X2 test and Spearman test showed the bleeding volume, the surgical operation and bleeding site had obvious correlation (p0,05). In June, patients were followed up to evaluate the prognosis of ADL, and puncture drainage was superior to small bone petal hematoma clearance. Conclusion the prognosis of patients with small bone flap hematoma is better than that of puncture drainage. Conclusion the prognosis of the patients is closely related to the preoperative GCS score, the site of bleeding and the amount of bleeding. Meanwhile, the choice of operation and the choice of the time of operation also seriously affect the quality of life in the patient's prognosis. Surgery and puncture drainage surgery for hypertensive intracerebral hemorrhage has a better effect on postoperative daily living ability. Methods according to the requirements of systematic evaluation, PubMed, Medline database, OVID, Wanfang full text database, CNKI database, data base of VIP Chinese sci-tech periodicals, CBM disk database, SCIENCEDIRECT database, etc. are included. The randomized controlled trials of all small craniotomy craniotomy hematoma removal and puncture drainage in the treatment of hypertensive intracerebral hemorrhage were included in a total of 20 randomized controlled groups, with a total of 4752 cases, the literature was extracted and the quality was evaluated. The related data were evaluated with RevMan5.3, and the mortality of two kinds of operations was analyzed by Meta and Results Meta analysis showed that: 1, the mortality rate of hypertensive intracerebral hemorrhage in the ultra early stage was [P=0.02, OR combined with =I.37,95%CI (0.29,6.59)], without statistical difference (P0.05); 2, the daily living ability (ADLI- III) within 6 months after operation. The hematoma puncture drainage group was superior to the small bone flap hematoma clearance group, [P=-0.25, OR-=2.47,95%CI (0.38,) 0.88)], P0.05, there were statistical differences; 3, mortality: small bone flap hematoma clearance was lower than that of [P=0.24,0R combined with =0.81,95%CI (0.66-0.98)], P0.05, with statistical difference; 4, rebleeding rate: the rate of rebleeding was [P=0.27, OR combined =1.41,95%CI (0.76-2.61)], P0.05, no statistical difference. Difference: 5, the rate of pulmonary infection: small bone flap hematoma clearance was higher than that of external drainage [P=0.002,0R and =1.8,95%CI (1.25-2.58)], P0.05, with statistical difference; 6, the bleeding rate of digestive tract: small bone flap hematoma removal and puncture drainage of digestive tract bleeding rate [P=0.16, OR and =1.44,95%CI (0.87-2.38)], P0.05, no statistical difference; 7, urine. The rate of road infection: the rate of urinary tract infection [P=1.04, OR-=I.04,95%CI (0.55-1.99)], P0.05, there was no statistical difference between small bone flap hematoma clearance and external drainage. Conclusion (1) the mortality of hypertensive intracerebral hemorrhage was treated by ultra early operation, and the mortality of the two methods of operation was basically the same, no statistical difference. (2) the daily living ability in 6 months after the operation. (ADL I - III), hematoma puncture drainage is superior to small bone flap hematoma clearance. (3) small bone flap hematoma removal surgical treatment of hypertensive intracerebral hemorrhage mortality is lower than puncture drainage. (4), small bone flap hematoma removal and puncture drainage treatment of hypertensive intracerebral hemorrhage postoperative rebleeding rate is basically the same, no statistical difference. (5) small bone petal hematoma clear clear In the treatment of postoperative complications of hypertensive intracerebral hemorrhage, the pulmonary infection rate was lower than that of small bone flap hematoma, and the two types of digestive tract bleeding and urinary tract infection were basically the same, with no statistical difference.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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