摘要
目的:研究钻孔引流术与骨瓣开颅血肿清除联合去骨瓣减压术治疗阿司匹林(ASA)相关幕上脑出血(SCH)的疗效和安全性。方法:选取2015年9月至2018年9月我院ASA相关SCH患者84例,采用简单随机化法均分为钻孔组和开颅组各42例进行干预,其中钻孔组实施钻孔引流术,开颅组则给予小骨窗开颅血肿清除术和去骨瓣减压术,比较两组血肿清除率,术后24h时NIHSS评分、GCS评分和GOS评分变化,术后6个月时日常生活能力、术后并发症发生率及患者病死率。结果:钻孔组手术时间、术中出血量、引流时间及住院时间均显著低于开颅组(P<0.05),两组血肿清除率无明显差异(P>0.05);术后24h,两组NIHSS评分明显降低(P<0.05),GCS及GOS评分明显升高(P<0.05),且钻孔组NIHSS评分低于开颅组,GCS及GOS评分高于对照组,差异有统计学意义(P<0.05);术后6个月时钻孔组患者日常生活能力明显优于开颅组(P<0.05),两组日常生活能力优良率分别为90.24%和84.21%(P>0.05);钻孔组和开颅组并发症发生率分别为21.43%和19.05%(P>0.05),死亡率分别为2.38%和4.76%(P>0.05)。结论:与开颅血肿清除术联合去骨瓣减压术相比,钻孔穿刺引流术操作简单、创伤小且术后康复速度快,同时能有效降低NIHSS评分,提升GCS和GOS评分并改善患者术后日常生活能力,且术后并发症发生率为明显增加。
Objective:To study the efficacy and safety of trepanation and drainage and bone flap craniotomy hematoma evacuation combined with decompressive craniectomy in the treatment of aspirin(ASA)-related supratentorial cerebral hemorrhage(SCH).Methods:84 patients with ASA-related SCH in our hospital from September 2015 to September 2018 were selected and divided into trepanation group and craniotomy group according to the simple randomization method,with 42 cases in each group.Trepanation group was given trepanation and drainage,and craniotomy group was given small bone window craniotomy hematoma evacuation and decompressive craniectomy.The hematoma clearance rate,the NIHSS score,GCS score and GOS score at 24 h after operation,ability of daily living at 6 months after operation,incidence rate of postoperative complications and mortality rate of patients were compared between the two groups.Results:The operative time,intraoperative blood loss,drainage time and hospital stay in trepanation group were significantly lower than those in craniotomy group(P<0.05),and there was no significant difference in the hematoma clearance rate between the two groups(P>0.05).At 24h after operation,the NIHSS score in the two groups was significantly decreased(P<0.05)while the scores of GCS and GOS were significantly increased(P<0.05),and the NIHSS score in trepanation group was lower than that in craniotomy group while the scores of GCS and GOS were higher than those in control group(P<0.05).At 6 months after operation,the ability of daily living in trepanation group was significantly better than that in craniotomy group(P<0.05),and the excellent and good rate of ability of daily living in the two groups were 90.24%and 84.21%respectively(P>0.05).The incidence rates of complications in trepanation group and craniotomy group were 21.43%and 19.05%respectively(P>0.05),and the mortality rates were 2.38%and 4.76%respectively(P>0.05).Conclusions:Compared with craniotomy hematoma evacuation combined with decompressive craniectomy,trepanation and puncture drainage has simpler operation,smaller trauma and quicker postoperative recovery,and it can effectively reduce NIHSS score,enhance scores of GCS and GOS and improve postoperative daily living ability,and increase significantly the incidence rate of postoperative complications.
作者
沈育
徐春林
程小志
何星河
张帅
SHEN Yu;XU Chunlin;CHENG Xiaozhi(Huanggang Central Hospital,Hubei Huanggang 438000,China)
出处
《河北医学》
CAS
2019年第11期1880-1884,共5页
Hebei Medicine
基金
湖北省卫生厅科研项目,(编号:15012054)
关键词
幕上脑出血
阿司匹林
钻孔引流术
小骨窗开颅血肿清除术
去骨瓣减压术
Supratentorial cerebral hemorrhage
Aspirin
Trepanation and drainage
Small bone window craniotomy hematoma evacuation
Decompressive craniectomy
