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目的探讨开颅血肿清除联合脑室外引流和单纯脑室外引流治疗高血压脑出血破入脑室的疗效。方法回顾性分析2012年6月至2015年6月3年内我院收治的70例接受手术治疗的高血压脑出血破入脑室患者的临床资料,其中脑室外引流联合开颅血肿清除(EVD+HE组)患者31例,单纯脑室外引流(EVD组)39例。比较两组患者的格拉斯哥昏迷评分(GCS)、神经外科重症监护室(NICU)住院天数、死亡率、肺部感染、颅内感染和再出血的发生率以及随访6个月后的改良Rankin量表(mRS)评分及格拉斯哥预后评分(GOS)。然后筛选比较两组中幕上血肿量>30mL患者的上述临床指标。结果术后住院期间EVD+HE组9例(29.0%)患者死亡,EVD组2例(5.1%)死亡,差异有统计学意义(P=0.008);其余存活患者继续纳入后续研究。EVD+HE组患者GCS评分增加值(ΔGCS)大于EVD组(P<0.05);两组患者NICU住院时间,术后再出血及肺部感染、颅内感染发生率,随访6个月后mRS及GOS评分的差异无统计学意义(P>0.05)。EVD+HE组幕上血肿量>30mL的患者ΔGCS、术后6个月mRS及GOS评分均优于EVD组(P<0.05),但NICU住院时间、术后再出血及肺部感染、颅内感染发生率与EVD组相比差异无统计学意义(P>0.05)。结论对于幕上血肿量>30mL的患者,开颅血肿清除联合脑室外引流术疗效优于单纯脑室外引流术。
Objective To investigate the curative effect of craniotomy hematoma removal combined with extracerebral ventricular drainage and simple ventricular drainage in the treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 70 patients with hypertensive intracerebral hemorrhage undergoing surgical treatment in our hospital from June 2012 to June 2015 were retrospectively analyzed. Among these patients, extracerebral venous drainage combined with cranial hematoma removal (EVD + HE Group) 31 patients, simple intraventricular drainage (EVD group) 39 cases. The Glasgow Coma Scale (GCS), length of stay in the neurosurgical intensive care unit (NICU), mortality, lung infection, intracranial infection and rebleeding were compared between the two groups as well as the modified Rankin scale after 6 months of follow-up (mRS) score and Glasgow Outcome Scale (GOS). Then compared the two groups in the supratentorial hematoma> 30mL patients with the above clinical indicators. Results Nine patients (29.0%) died in EVD + HE group during hospitalization. Two patients died in EVD group (5.1%), with statistical significance (P = 0.008). The remaining survivors were included in the follow-up study. The value of GCS score (ΔGCS) in EVD + HE group was greater than that in EVD group (P <0.05). The length of NICU hospital stay, postoperative rebleeding and pulmonary infection, the incidence of intracranial infection, mRS and There was no significant difference in GOS score (P> 0.05). In the EVD + HE group, the ΔGCS of the supratentorial hematoma> 30mL was significantly higher than that of the EVD group at 6 months (P <0.05), but the hospital stay of NICU, postoperative hemorrhage and pulmonary infection, intracranial There was no significant difference in the incidence of infection between EVD group and EVD group (P> 0.05). Conclusion For patients with supratentorial hematoma> 30mL, craniocerebral hematoma combined with intraventricular drainage is more effective than simple ventricular drainage.