雷明

摘 要：目的 研究微創穿刺引流联合开颅血肿清除术治疗高血压脑出血并发脑疝患者的临床效果。方法 选取2015年5月～2017年2月我院52例高血压脑出血并发脑疝患者，按随机数字表法分为观察组和对照组，每组26例。对照组采用开颅血肿清除术联合去骨瓣减压术治疗，观察组采取微创穿刺引流+开颅血肿清除术+去骨瓣减压术治疗，治疗后随访6个月，对比两组临床效果、并发症发生率、预后状况（GOS）分级及预后生活质量（HPLP-Ⅱ）评分。结果 观察组治疗总有效率高于对照组（96.15% vs. 69.23%），差异有统计学意义（P<0.05）；观察组并发症发生率低于对照组（11.54% vs. 38.46%），差异有统计学意义（P<0.05）；观察组GOS分级优于对照组，HPLP-Ⅱ评分高于对照组，差异有统计学意义（P<0.05）。结论 高血压脑出血并发脑疝患者采取微创穿刺引流联合开颅血肿清除术治疗，可提高治疗有效率，减少并发症，改善预后康复状况及生活质量水平。

关键词：高血压脑出血；脑疝；微创穿刺引流

中图分类号：R651.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.07.028

文章编号：1006-1959（2018）07-0089-03

Clinical Effect of Minimally Invasive Puncture Drainage Combined with Craniotomy Hematoma in the Treatment of Hypertensive Cerebral Hemorrhage Complicated with Cerebral Hernia

LEI Ming

（Department of Surgery，Subject One，Changning County Traditional Chinese Medicine Hospital，Changning 644300，Sichuan，China）

Abstract：Objective To study the clinical effect of minimally invasive puncture and drainage combined with craniotomy for the treatment of hypertensive cerebral hemorrhage complicated with cerebral hernia.Methods 52 patients with hypertensive intracerebral hemorrhage complicated with cerebral hernia from May 2015 to February 2017 were randomly divided into two groups：observation group（n=26）and control group（n=26）.The control group was treated by craniotomy combined with bone flap decompression，the observation group was treated by minimally invasive puncture drainage+craniotomy and hematoma removal+decompressive craniectomy.After 6 months follow-up， the clinical efficacy，complication rate，prognosis（GOS）grade and prognosis quality of life （HPLP-II） score of the two groups were compared.Results The total efficiency of the observation group is higher than that of control group（96.15%vs.69.23%），the difference was statistically significant（P<0.05）；the incidence of complications in observation group lower than in the control group（11.54%vs.38.46%），the difference was statistically significant（P<0.05）；the observation group GOS grade better than the control group，HPLP-Ⅱ score higher than the control group，the difference was statistically significant（P<0.05）.Conclusion Hypertensive cerebral hemorrhage complicated with cerebral hernia is treated by minimally invasive puncture drainage combined with craniotomy and evacuation of hematoma.It can improve the treatment efficiency，reduce complications，improve prognosis，rehabilitation status and quality of life.

Key words：Hypertensive intracerebral hemorrhage；Brain hernia；Minimally invasive puncture and drainage

高血压脑出血（hypertensive cerebral hemorrhage）易并发脑疝，导致脑部组织出现系列病理改变，病情危重，致死致残率高，临床给予高度重视[1]。有研究显示，血肿形成半小时后即可导致脑实质海绵样病变，周围出现坏死层并开始不断扩展，因此临床以尽早清除血肿，降低颅内压为治疗要义[2]。开颅血肿清除术联合去骨瓣减压术是治疗高血压脑出血合并脑疝常用术式，术前需行全面检查，准备时间可达1～1.5 h，易错过最佳治疗时机[3]。微创穿刺引流是近年来新型微创手术，可立即对患者进行抢救，短时间内降低颅内压，阻断脑部恶性循环，之后再行血肿清除术，成功率更高[3]。因此，本研究选择52例高血压脑出血并发脑疝患者分组对比，研究微创穿刺引流联合开颅血肿清除术的临床效果。

1资料与方法

1.1一般资料 选取2015年5月～2017年2月长宁县中医医院52例高血压脑出血并发脑疝患者，按随机抽签法分为观察组和对照组，每组26例。……