微創(chuàng)雙管置入治療高血壓腦出血的臨床評價
發(fā)布時間：2018-10-22 20:34
【摘要】：目的研究與比較不同術式(微創(chuàng)雙管置入引流術聯(lián)合尿激酶注入與傳統(tǒng)開顱血腫清除術)、不同手術時機(超早期手術與早期手術)治療高血壓腦出血的療效。方法回顧性分析唐山市豐潤區(qū)醫(yī)院神經(jīng)外科2013年1月~2015年1月收治的高血壓腦出血急性期患者64例,其中開顱血腫清除術患者25例(包括超早期手術6例,早期組19例);微創(chuàng)雙管置入術39例(其中超早期組25例,早期組14例)。記錄患者人口學特征(年齡、性別、血腫部位和血腫深度);采用格拉斯哥意識障礙評分(Glasgow Coma Scale,GCS)評估入院時和發(fā)病后1 w意識水平;記錄首次血腫清除率、血腫消失時間、手術時間和住院天數(shù);出院后死亡率、再出血情況及并發(fā)癥情況。采用格拉斯哥預后量表(Glasgow outcome scale,GOS)和日常生活能力評分(Daily life ability score,ADL)評估患者術后6月的生活質(zhì)量。。結果與傳統(tǒng)開顱血腫清除術比較,微創(chuàng)雙管置入引流術聯(lián)合尿激酶注入能夠顯著:1降低手術時間和住院天數(shù),差異具有統(tǒng)計學意義(χ2=115.698,P=0.000;χ2=11.199,P=0.000);2減低術后并發(fā)癥發(fā)生率,差異具有統(tǒng)計學意義(χ2=5.517,P=0.023);3降低出院后死亡率(χ2=4.675,P=0.031);4改善預后,出院6個月患者GOS大于等級4以上者與傳統(tǒng)開顱血腫清除術組比較,差異具有統(tǒng)計學意義(χ2=4.441,P=0.035);5促進患者生活質(zhì)量的提高,出院6個月患者ADL評分大于40分以上者與傳統(tǒng)開顱血腫清除術組比較,差異具有統(tǒng)計學意義(χ2=4.582,P=0.032)。而微創(chuàng)手術超早期與早期手術相比,在術后GCS評分、首次血腫清除率、手術時間、住院天數(shù)、術后并發(fā)癥發(fā)生率、出院后死亡率、術后GOS和ADL評分方面差異無統(tǒng)計學意義(P0.05)。結論微創(chuàng)雙管置入術聯(lián)合尿激酶注入較傳統(tǒng)的開顱血腫清除術能夠有效降低術后并發(fā)癥和住院時間,改善患者預后和生活質(zhì)量,同時超早期進行微創(chuàng)手術對于治療高血壓腦出血來講較為安全、有效。
[Abstract]:Objective to study and compare the effects of different surgical procedures (minimally invasive double-tube drainage combined with urokinase injection and traditional craniotomy for hematoma removal) and different operative time (ultra-early operation and early operation) in the treatment of hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods from January 2013 to January 2015, 64 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed in the neurosurgery department of Fengrun District Hospital of Tangshan, including 25 patients with craniotomy and hematoma clearance (including 6 cases of ultra-early operation). There were 19 cases in the early stage group and 39 cases in the minimally invasive double tube implantation group (25 cases in the super early group and 14 cases in the early group). The demographics (age, sex, location and depth of hematoma) were recorded, Glasgow consciousness disorder score (Glasgow Coma Scale,GCS) was used to assess the consciousness level at admission and 1 week after onset, the clearance rate of the first hematoma and the time of hematoma disappearance were recorded. Operative time and hospital stay, mortality, rebleeding and complications after discharge. Glasgow prognosis scale (Glasgow outcome scale,GOS) and ADL score (Daily life ability score,ADL) were used to evaluate the quality of life (QOL) 6 months after operation. Results compared with traditional craniotomy and hematoma removal, minimally invasive double-tube drainage combined with urokinase injection could significantly reduce the operative time and hospital stay (蠂 ~ 2 / 115.698P ~ (0.000), 蠂 ~ (2 +) 11.199 / P ~ (0.000), reduce the incidence of postoperative complications. The difference was statistically significant (蠂 ~ 2 / 5.517p ~ (0.023), (3) the mortality rate after discharge (蠂 ~ (2) = 4.675) was decreased (蠂 ~ (2) = 4.675), (4) the prognosis was improved, the difference was statistically significant (蠂 ~ (2 +) 4.441P _ (0.035), (5) the quality of life was improved in patients whose GOS was greater than grade 4 (n = 6) than that in the traditional craniotomy group (蠂 ~ (2 +) 4.441P0.035). There was a significant difference between the patients with ADL score more than 40 months after discharge and the traditional craniotomy group (蠂 2 = 4.582 P < 0.032). However, there was no significant difference in postoperative GCS score, first hematoma clearance rate, operation time, hospital stay, postoperative complication rate, mortality rate after discharge, postoperative GOS and ADL score between early and early stage of minimally invasive surgery (P0.05). Conclusion minimally invasive double tube implantation combined with urokinase injection can effectively reduce postoperative complications and hospital stay and improve the prognosis and quality of life of patients compared with traditional craniotomy. At the same time, ultra-early minimally invasive surgery is safe and effective in the treatment of hypertensive intracerebral hemorrhage.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.11
，
本文編號：2288240
[Abstract]:Objective to study and compare the effects of different surgical procedures (minimally invasive double-tube drainage combined with urokinase injection and traditional craniotomy for hematoma removal) and different operative time (ultra-early operation and early operation) in the treatment of hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods from January 2013 to January 2015, 64 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed in the neurosurgery department of Fengrun District Hospital of Tangshan, including 25 patients with craniotomy and hematoma clearance (including 6 cases of ultra-early operation). There were 19 cases in the early stage group and 39 cases in the minimally invasive double tube implantation group (25 cases in the super early group and 14 cases in the early group). The demographics (age, sex, location and depth of hematoma) were recorded, Glasgow consciousness disorder score (Glasgow Coma Scale,GCS) was used to assess the consciousness level at admission and 1 week after onset, the clearance rate of the first hematoma and the time of hematoma disappearance were recorded. Operative time and hospital stay, mortality, rebleeding and complications after discharge. Glasgow prognosis scale (Glasgow outcome scale,GOS) and ADL score (Daily life ability score,ADL) were used to evaluate the quality of life (QOL) 6 months after operation. Results compared with traditional craniotomy and hematoma removal, minimally invasive double-tube drainage combined with urokinase injection could significantly reduce the operative time and hospital stay (蠂 ~ 2 / 115.698P ~ (0.000), 蠂 ~ (2 +) 11.199 / P ~ (0.000), reduce the incidence of postoperative complications. The difference was statistically significant (蠂 ~ 2 / 5.517p ~ (0.023), (3) the mortality rate after discharge (蠂 ~ (2) = 4.675) was decreased (蠂 ~ (2) = 4.675), (4) the prognosis was improved, the difference was statistically significant (蠂 ~ (2 +) 4.441P _ (0.035), (5) the quality of life was improved in patients whose GOS was greater than grade 4 (n = 6) than that in the traditional craniotomy group (蠂 ~ (2 +) 4.441P0.035). There was a significant difference between the patients with ADL score more than 40 months after discharge and the traditional craniotomy group (蠂 2 = 4.582 P < 0.032). However, there was no significant difference in postoperative GCS score, first hematoma clearance rate, operation time, hospital stay, postoperative complication rate, mortality rate after discharge, postoperative GOS and ADL score between early and early stage of minimally invasive surgery (P0.05). Conclusion minimally invasive double tube implantation combined with urokinase injection can effectively reduce postoperative complications and hospital stay and improve the prognosis and quality of life of patients compared with traditional craniotomy. At the same time, ultra-early minimally invasive surgery is safe and effective in the treatment of hypertensive intracerebral hemorrhage.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.11
，
本文編號：2288240
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