發(fā)布時(shí)間：2019-01-28 18:05

【摘要】：目的觀察單純側(cè)腦室穿刺置管引流術(shù)和神經(jīng)內(nèi)鏡下血腫清除術(shù)兩種手術(shù)方式治療高血壓性TH并破入腦室伴幕上急性梗阻性腦積水的臨床效果,為高血壓TH破入腦室伴急性梗阻性腦積水患者的臨床手術(shù)治療,提供選擇依據(jù)。方法完全依照納入與排除標(biāo)準(zhǔn),并加以回顧性調(diào)查的方式,選取自2010年01月至2014年10月于鄭州大學(xué)第一附屬醫(yī)院及鄭州市金水區(qū)總醫(yī)院就診的高血壓性TH破入腦室伴不同程度急性梗阻性腦積水患者,共計(jì)60例,隨機(jī)分為2組觀察組(30例),對(duì)照組(30例)。所有患者均常規(guī)給予降低顱內(nèi)壓、營養(yǎng)腦細(xì)胞、控制血壓、糾正電解質(zhì)紊亂及酸堿失衡、減輕腦缺氧及CO2蓄積、腦水腫及各種合并癥等對(duì)癥支持治療,同時(shí)完善相關(guān)檢查,做好術(shù)前準(zhǔn)備工作。對(duì)照組采用單純側(cè)腦室穿刺置管引流術(shù),觀察組采用神經(jīng)內(nèi)鏡下血腫清除術(shù)。于術(shù)后第1 d、7 d、14 d、21 d分別復(fù)查兩組患者的頭顱CT,判斷腦室內(nèi)出血的消散時(shí)間,并觀察術(shù)后顱內(nèi)再出血、交通性腦積水、消化道出血、顱內(nèi)感染、等并發(fā)癥的發(fā)生情況及拔腦室引流管時(shí)間及平均住院天數(shù)。術(shù)后常規(guī)隨訪患者至患者死亡或滿6月為止,臨床療效的評(píng)價(jià)按日常生活能力分級(jí)法(ADL)進(jìn)行,其中術(shù)后恢復(fù)良好包括ADLⅠ~Ⅲ級(jí),療效較差者為ADLⅣ~Ⅴ級(jí)。收集數(shù)據(jù),并進(jìn)行統(tǒng)計(jì)分析。結(jié)果60例入選患者的臨床特征與手術(shù)相關(guān)變量是相吻合的。觀察組患者年齡56.0±5.6歲,出血量31.0±15.6 ml,手術(shù)距發(fā)病時(shí)間10.8±3.2 h,GCS評(píng)分9.6±3.0;對(duì)照組年齡56.0±5.9歲,出血量31.6±17.2 ml,手術(shù)距發(fā)病時(shí)間10.2±3.6 h,GCS評(píng)分10.1±3.4。兩組患者間的術(shù)前一般資料無顯著差異(p0.05)。觀察組有2例患者死亡,病死率6.7%,恢復(fù)良好率73.3%;對(duì)照組有5例患者死亡,病死率16.7%,恢復(fù)良好率43.3%。觀察組與對(duì)照組患者的恢復(fù)良好率比較,差異有統(tǒng)計(jì)學(xué)意義(χ2=4.39,p=0.04)。觀察組術(shù)后存活患者28例,腦室血腫消散時(shí)間≤7 d者23例,所占比率為82.1%,明顯高于對(duì)照組(52.0%),差異有統(tǒng)計(jì)學(xué)意義(χ2=5.51,p0.01)。觀察組交通性腦積水患者1例(3.3%),較對(duì)照組(16.7%)的發(fā)生率明顯更低,且兩組間發(fā)生率差異顯著(p0.01,χ2=15.15)。觀察組顱內(nèi)感染患者3例(10.0%),發(fā)生率明顯低于對(duì)照組(23.3%),觀察組消化道出血患者3例(6.67%)、術(shù)后顱內(nèi)再出血患者1例(3.33%),與對(duì)照組相比較,其發(fā)生率差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論神經(jīng)內(nèi)鏡下血腫清除既能及時(shí)解除急性梗阻性腦積水降低顱內(nèi)壓,又可以處理丘腦血腫,能徹底治療由三腦室受壓引起的腦脊液循環(huán)障礙,而且在治療效果上明顯優(yōu)于單純行側(cè)腦室穿刺引流術(shù),很少出現(xiàn)并發(fā)癥。其在高血壓性TH破入腦室合并梗阻性腦積水治療方面取得了良好的療效,是該類患者的首選手術(shù)方案,可進(jìn)一步推廣應(yīng)用于臨床實(shí)踐。
[Abstract]:Objective to observe the clinical effect of simple lateral ventricular puncture catheter drainage and endoscopic hematoma removal in the treatment of hypertensive TH with acute supratentorial obstructive hydrocephalus. To provide the basis of choice for the clinical treatment of hypertensive patients with acute obstructive hydrocephalus after TH breaking into the ventricle. Methods in full accordance with the inclusion and exclusion criteria and with retrospective investigations, From January 2010 to October 2014, 60 patients with acute obstructive hydrocephalus and hypertensive TH broken into the ventricle were selected from the first affiliated Hospital of Zhengzhou University and General Hospital of Jinshui District of Zhengzhou City. They were randomly divided into two groups: observation group (30 cases) and control group (30 cases). All the patients were given routine treatment of lowering intracranial pressure, nourishing brain cells, controlling blood pressure, correcting electrolyte disturbance and acid-base imbalance, reducing cerebral hypoxia and CO2 accumulation, brain edema and various complications, and improving relevant examination. Prepare for the operation. The control group was treated with simple lateral ventricular puncture and drainage, and the observation group with neuroendoscope hematoma clearance. The brain CT, of the two groups were examined on the 1st day, 7th day, 14th day and 21st day, respectively, to determine the time of dissipation of intraventricular hemorrhage, and to observe the postoperative intracranial rebleeding, communicating hydrocephalus, gastrointestinal hemorrhage and intracranial infection. The occurrence of the complications, the time of pulling out the ventricular drainage tube and the average length of hospitalization. The clinical efficacy was evaluated according to the activity of daily living (ADL) classification (ADL). The postoperative recovery included ADL 鈪，

本文編號(hào)：2417161