摘要
目的探讨高血压脑出血合并脑疝开颅减压术前联合微创穿刺术治疗的临床价值。方法将我院2017年5月~2018年5月收治的40例高血压脑出血合并脑疝患者随机分为对照组20例和观察组20例,对照组患者采用常规开颅血肿清除并去骨瓣减压术治疗,观察组患者在开颅血肿清除并去骨瓣减压术前联合微创穿刺术治疗,进行生活质量(QOL)量表、日常生活活动能力量表(ADL)、格拉斯哥转归量表(GOS)评分及近远期疗效评估,测定大脑中动脉平均流速(Vm)、大脑中动脉搏动指数(PI),统计入院至手术完成时间及再出血情况。结果观察组和对照组术后1个月、6个月的ADL评分较术前明显降低,差异有统计学意义(P<0.05),且观察组术后1个月、6个月的ADL评分明显低于对照组(P<0.05)。观察组术后1个月、6个月的QOL明显高于对照组(P<0.05)。观察组术后6个月的临床预后明显优于对照组,差异有统计学意义(Z=-3.501,P<0.01);对照组术后1个月的临床总有效率为45%(9/20),低于观察组75%(15/20),差异有统计学意义(χ^2=6.750,P<0.05);对照组术后6个月的临床总有效率为65%(13/20),低于观察组95%(19/20),差异有统计学意义(χ^2=8.710,P<0.05)。观察组和对照组术后1个月、6个月的Vm均较术前明显升高(P<0.05),PI较术前明显降低(P<0.05);观察组术后1个月、6个月的Vm明显高于对照组(P<0.05),PI明显低于对照组(P<0.05)。对照组和观察组入院至手术完成时间分为(200.6±20.4)min和(208.2±15.8)min,差异无统计学意义(t=0.967,P>0.05);对照组术后再出血率为25%(5/20),观察组术后再出血率为5%(1/20),差异无统计学意义(χ^2=3.137,P>0.05)。结论高血压脑出血合并脑疝行开颅减压术前联合微创穿刺术能有效改善脑血流情况及减轻神经功能缺损,提高临床疗效,改善临床预后及生活质量,是抢救高血压脑出血突发脑疝患者的有效方法。
Objective To investigate the clinical value of decompressive craniectomy combined with minimally invasive puncture in patients with hypertensive cerebral hemorrhage combined with cerebral hernia.Methods 40 patients with hypertensive intracerebral hemorrhage and cerebral hernia who were treated in our hospital from May 2017 to May 2018 were randomly divided into a control group(n=20)and an observation group(n=20).The control group was given conventional craniotomy to remove hematoma and decompressive craniectomy,while the observation group was treated with minimally invasive puncture before the operation in the control group.The quality of life(QOL)scale,the activities of daily life scale(ADL),the Glasgow outcome scale(GOS)score and short-term and long-term curative effect were compared between the two groups.The cerebral artery velocity of mean(Vm),middle cerebral artery pulsation index(PI)were measured,and the time from admission to completion of surgery and rebleeding were counted.Results The ADL scores of the observation group and the control group at 1 and 6 months after surgery were significantly lower than those before surgery(P<0.05),and the ADL scores of the observation group at 1 and 6 months after surgery were significantly lower than those of the control group(P<0.05).The QOL score of the observation group at 1 and 6 months after surgery was significantly higher than that of the control group(P<0.05).The clinical prognosis of the observation group at 6 months after surgery was significantly better than that of the control group,the difference was statistically significant The total clinical effective rate at 1 month after surgery in the control group was 45%(9/20),which was lower than 75%(15/20)in the observation group,and the difference was statistically significant(χ^2=6.750,P<0.05);the total clinical effective rate at 6 months after surgery in the control group was 65%(13/20),which was lower than 95%(19/20)in the observation group,and the difference was statistically significant(χ^2=8.710,P<0.05).The Vm at 1 and 6 months after surgery in both groups were significantly higher than those before surgery(P<0.05),and the PI was significantly lower than that before surgery(P<0.05);the Vm of the observation group at 1 and 6 months after surgery was significantly higher than that of the control group(P<0.05),and PI was significantly lower than that of the control group(P<0.05).The time from admission to the completion of surgery in the control group and observation group was(200.6±20.4)min and(208.2±15.8)min,respectively,and the difference was not statistically significant(t=0.967,P>0.05).The postoperative bleeding rate in the control group was 25%(5/20),which was higher than 5%(1/20)in the observation group,and the difference was not statistically significant(χ^2=3.137,P>0.05).Conclusion The application of decompressive craniotomy combined with minimally invasive puncture for hypertensive cerebral hemorrhage combined with cerebral hernia can effectively improve cerebral blood flow and reduce neurological deficits,and promote clinical efficacy,clinical prognosis and quality of life.It is an effective method for hypertensive intracerebral hemorrhage patients with sudden hernia.
作者
黄坚
杜春生
吴彬冰
HUANG Jian;DU Chunsheng;WU Binbing(Department of Neurosurgery,Puning Overseas Chinese Hospital,Guangdong,Jieyang 515300,China)
出处
《中国医药科学》
2020年第7期23-27,共5页
China Medicine And Pharmacy
基金
广东省揭阳市科技计划项目(2018wsyl019)。
关键词
高血压脑出血
脑疝
微创穿刺术
开颅减压术
脑血流
神经功能缺损
Hypertensive cerebral hemorrhage
Cerebral hernia
Minimally invasive puncture
Decompressive craniotomy
Cerebral blood flow
Neurological deficit
