袁雪松 卞晓星 包卿 魏文锋 金鹏 刘平

[摘要] 目的 探讨不同外科术式治疗高血压脑出血的效果与安全性。 方法 选取2015年1月～2017年7月在我院住院治療的高血压脑出血患者84例，根据手术术式的不同，采用随机数字法分为常规开颅组（52例）和微创组（32例），开颅组患者给予开颅血肿清除术，微创组患者给予软通道微创穿刺引流术，比较两组患者的术中相关指标（血肿清除率、手术时间及术中出血量）、临床治疗效果及术后并发症（颅内感染、肺部感染、水电解质平衡紊乱和颅内再出血）的发生率。 结果 与开颅组相比，微创组患者的手术时间显著缩短，术中出血量显著降低，差异具有统计学意义（P<0.05）；微创组患者手术治疗的总有效率为93.75%，开颅组患者手术治疗的总有效率为76.92%，差异具有统计学意义（P<0.05）；微创组患者术后并发症的总发生率为37.50%，开颅组患者术后并发症的总发生率为38.46%，两组相比，差异无统计学意义（P>0.05）。 结论 微创穿刺引流术治疗高血压脑出血患者的临床效果较好，但实际应用中仍应具体情况具体分析，选择最佳的术式。

[关键词] 开颅血肿清除术；微创穿刺引流术；高血压脑出血；安全性

[中图分类号] R651.1 [文献标识码] B [文章编号] 1673-9701（2018）30-0078-04

[Abstract] Objective To investigate the effect and safety of different surgical treatments for hypertensive intracerebral hemorrhage. Methods A total of 84 patients with hypertensive intracerebral hemorrhage who were hospitalized in our hospital from January 2015 to July 2017 were enrolled. According to different surgical procedures， they were randomly divided into conventional craniotomy group （52 cases） and minimally invasive group （32 cases）. Patients in the craniotomy group were treated with craniotomy hematoma evacuation， and patients in the minimally invasive group were given soft-channel minimally invasive puncture drainage. The intraoperative related indexes（hematoma clearance rate， operation time and intraoperative blood loss）， the incidence of clinical treatment and postoperative complications （intracranial infection， pulmonary infection， water-electrolyte balance disorder and intracranial rebleeding） were compared between the two groups. Results Compared with that of the craniotomy group， the operation time in the minimally invasive group was significantly shortened， and the intraoperative blood loss was significantly lower， and the difference was statistically significant（P<0.05）. The total effective rate of surgical treatment in the minimally invasive group was 93.75%， and the total effective rate of surgical treatment in the craniotomy group was 76.92%， and the difference was statistically significant（P<0.05）. The total incidence of postoperative complications in the minimally invasive group was 37.50%. The total incidence of postoperative complications in the craniotomy group was 38.46%. There was no significant difference between the two groups （P>0.05）. Conclusion The clinical effect of minimally invasive puncture drainage in patients with hypertensive intracerebral hemorrhage is better， but the actual application should be analyzed in detail and the best surgical procedure should be selected.

[Key words] Craniotomy hematoma evacuation； Minimally invasive puncture drainage； Hypertensive cerebral hemorrhage； Safety

高血壓脑出血（hypertensive cerebral hemorrhage，HCH）是临床上常见的神经系统疾病，具有病情进展快、致残率、致死率高等特点。对于出血量较多的重症患者，通常会采用手术方法进行治疗[1-2]。开颅血肿清除术是目前常用的手术术式，具有快速清除血肿、直视下止血等优点，然而开颅手术具有损伤大、术后并发症多、神经功能恢复慢等缺点[3]。近年来，软通道微创穿刺引流术在治疗高血压脑出血上应用越来越广泛，其具有创伤小、安全性高及神经功能恢复快等优点[4-5]。基于此，本研究观察不同外科术式治疗高血压脑出血的临床效果与安全性，现报道如下。……