陈刚程继勇

开颅血肿清除术和钻孔引流术治疗高血压脑出血疗效比较

陈刚*程继勇**

目的比较开颅血肿清除术和钻孔引流术治疗高血压脑出血的效果。方法回顾性分析因高血压脑出血采取开颅血肿清除术（开颅组，n=39）和钻孔引流术（钻孔组，n=50）的患者，记录两组患者手术时间及血肿清除率、并发症、病死人数以及术后4h、24h、48h、72h、5d及7d的颅内压。结果术后开颅组和钻孔组治疗后颅内压在术后48h内均呈逐渐上升趋势，48h后呈逐渐下降趋势，但开颅组上升的幅度小于钻孔组，两组的组间（F=20.158，P=0.027）、不同时点（F=18.135，P=0.032）以及组间和不同时点的交互作用（F=32.524，P=0.006）均有统计学意义。开颅组术后血肿清除率（80.3%±9.6%）高于钻孔组（52.5%±5.4%），但是开颅组手术时间（130.7min± 8.9min）以及肺部感染率（64.1%）均高于钻孔引流组（50.3min±12.5min，32.0%），差异有统计学意义（P＜0.05）。结论开颅组较钻孔引流组可以增加血肿清除率，明显降低颅内压以及再出血的发生，但是会延长手术时间以及增加肺部感染的风险。应综合考虑患者的一般情况，再选择合适的手术方式。

高血压脑出血；钻孔引流；开颅血肿清除

【Abstract】ObjectiveTo compare the clinical effect of craniotomy versus sphenotresia drainage for treatment pa⁃tients with hypertensive cerebral hemorrhage.Methods Retrospective analysis the patients with hypertensive cerebral hemorrhage in our hospital，and divided into the group of craniotomy（n=39）and the group of sphenotresia drainage（n=50）. The operating time，hematoma clearance rate，complications after operation and intracranial pressure at 4h，24h，48h，72h，5d and 7d after operation between the two groups were record.Results The intracranial pressure in both groups are raised gradually in the 48 h after surgery and gradually declined at 48 h after surgery.The increasing amplitude in craniotomy group is less than the group of sphenotresia drainage.Between the two groups of group，different point，and between groups and the interaction of the different point difference had statistical significance（P＜0.05）.The hematoma clearance rate in the group of craniotomy is less than the group of sphenotresia drainage.However，the operating time and the infection rates in the group of craniotomy is greater than the group of sphenotresia drainage，the difference is statistically significant（P＜0.05）.Conclusion Craniotomy can increase the hematoma clearance rate，decrease intracranial pressure as well as the oc⁃currence of rehaemorrhagia，however，it also will prolong operation time and increase the risk of lung infection and gastro⁃intestinal bleeding.It is depend on the general characteristic of patients to determine which operation methods to adopt.

【Key words】Hypertensive cerebral hemorrhage Sphenotresia drainage Craniotomy

钻孔引流术和开颅血肿清除术是临床上治疗高血压脑出血（hypertensive cerebral hemorrhage，HICH）常用的手术方法，尽管之前有研究比较了钻孔引流术和开颅血肿清除术对HICH患者术后颅内压的变化，但是关于这两种手术方式对中等出血量的HICH后并发症以及神经功能缺损情况尚未报道［1］，为此，我们采用回顾性分析的方法对比这两种手术方法对于HICH患者术后疗效，为临床手术方式的选择提供依据。……