后颅窝快速钻孔穿刺置管引流术治疗小脑出血的效果观察

钟鸣; 吴春泉; 王卫连

doi:10.7619/jcmp.202021018

后颅窝快速钻孔穿刺置管引流术治疗小脑出血的效果观察

江西省会昌县人民医院神经外科, 江西赣州, 342600

基金项目:

江西省赣州市指导性科技计划任务(GZ2019ZSF521)

详细信息

中图分类号: R651.1
计量
- 文章访问数: 281
- HTML全文浏览量: 17
- PDF下载量: 9
出版历程
- 收稿日期: 2020-08-27
- 网络出版日期: 2020-12-21
- 发布日期: 2020-11-23

Effect of rapid puncture and drainage by indwelling tube through drilling hole of posterior cranial fossa in the treatment of cerebellar hemorrhage

Department of Neurosurgery, People's Hospital of Huichang County in Jiangxi Province, Ganzhou, Jiangxi, 342600

摘要

摘要: 目的观察后颅窝快速钻孔穿刺置管引流术治疗小脑出血患者的效果。方法选取80例小脑出血患者作为研究对象,按照随机数表法分为研究组和对照组,每组40例。对照组采用传统开颅血肿清除术治疗,研究组采用后颅窝快速钻孔置管引流术治疗。比较2组患者术前血肿体积、术中出血量、手术时间、术后血肿清除时间、住院时间等手术相关指标和手术前后Barthel评分、治疗效果、术后并发症发生情况。结果研究组治疗效果良好率为77.5%, 高于对照组的52.5%, 差异有统计学意义(P<0.05)。研究组术中出血量少于对照组,手术时间、术后血肿清除时间、住院时间均短于对照组,差异有统计学意义(P<0.05); 2组术前血肿体积比较,差异无统计学意义(P>0.05)。术前, 2组Barthel评分比较,差异无统计学意义(P>0.05); 术后1个月, 2组Barthel评分均高于术前,且研究组Barthel评分高于对照组,差异有统计学意义(P<0.05)。研究组术后并发症发生率为7.5%, 低于对照组的32.5%, 差异有统计学意义(P<0.05)。结论相较于传统开颅血肿清除术,后颅窝快速钻孔置管引流术治疗小脑出血具有手术创伤小、手术时间短、治疗效果好、并发症少、患者恢复佳、对手术设备要求低等优点,易在基层医院中开展。
- 小脑出血 /
- 后颅窝快速钻孔穿刺 /
- 置管引流术 /
- 开颅血肿清除术
Abstract: Objective To observe the effect of rapid puncture and drainage by indwelling tube through drilling hole of posterior cranial fossa in the treatment of cerebellar hemorrhage. Methods A total of 80 patients with cerebellar hemorrhage were selected as research objects. According to random number table method, they were divided into study group and control group, with 40 cases in each group. The control group was treated with traditional craniotomy and hematoma clearance, while the study group was treated with rapid drainage by indwelling tube through drilling hole of posterior cranial fossa. The preoperative hematoma volume, intraoperative blood loss, operation time, postoperative hematoma clearance time, hospitalization time, Barthel score before and after operation, treatment effect and postoperative complications were recorded. Results The total good rate of the study group was 77.5%, which was significantly higher than 52.5% of the control group(P<0.05); the intraoperative blood loss was less, operation time, postoperative hematoma clearance time and hospital stay in the study group were significantly shorter than those in the control group(P<0.05), but there was no significant difference in preoperative hematoma volume between the two groups(P>0.05). Before operation, there was no significant difference in Barthel score between the two groups(P>0.05). At 1 month after operation, the Barthel scores of the two groups was significantly higher than operation before, and the Barthel score of the study group was significantly higher than that of the control group(P<0.05); the incidence of postoperative complications in the study group was 7.5%, which was significantly lower than 32.5% of the control group(P<0.05). Conclusion Compared - with traditional hematoma evacuation by craniotomy, rapid puncture and drainage by indwelling tube through drilling hole of posterior cranial fossa in treating cerebellar hemorrhage has the advantages of less operation trauma, shorter operation time, less complications, better curative efficacy and recovery, and lower requirements for surgical equipment. Therefore, it is easy to carry out this project in primary hospitals.
- cerebellar hemorrhage /
- rapid puncture through drilling hole of posterior cranial fossa /
- drainage by indwelling tube /
- hematoma evacuation by craniotomy

HTML全文

参考文献(18)

聂柳, 李胜斌, 夏鹰, 等. 影响外伤性小脑出血预后的因素分析[J]. 海南医学院学报, 2011, 17(9): 1211-1211

, 1215.

HEMPHILL J C, AMIN-HANJANI S. Cerebellar intracerebral hemorrhage: time for evidence-based treatment[J]. JAMA, 2019, 322(14): 1355-1356.

籍彦生, 雷国亮, 李奎智, 等. 多种方法联合治疗伴有脑室血肿的小脑出血[J]. 河北医药, 2014, 36(23): 3577-3579.

顾向进, 王东, 张党林, 等. 自发性小脑出血手术治疗策略[J]. 中国实用神经疾病杂志, 2017, 20(10): 35-38.

中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6): 435-444.

方俊, 朱晓江. 外伤性小脑出血的诊治[J]. 中国医药导刊, 2011, 13(6): 935-937.

许先平, 陈世洁, 吴明灿, 等. 自发性小脑出血的外科治疗选择[J]. 中国临床神经外科杂志, 2007, 12(3): 160-161.

胡庆山, 孙国柱, 赵宗茂, 等. 高血压性小脑出血的诊断和治疗[J]. 河北医药, 2004, 26(2): 160-161.

杨建军, 杨德智, 刘浩, 等. 高血压小脑出血的手术治疗[J]. 中外医疗, 2013, 32(7): 59-60.

张春声, 赵晓乐, 刘凌, 等. 显微手术治疗小脑出血26例分析[J]. 内蒙古中医药, 2013, 32(5): 115-118.

关国樑, 黄志雄, 林启明. 22例小脑出血的手术治疗分析[J]. 中国微侵袭神经外科杂志, 2003, 8(5): 229-229.

GILLIGAN J, GOLOGORSKY Y. Cerebellar intracerebral hemorrhage treatment: better evidence-based studies needed[J]. World Neurosurg, 2020, 134: 656-657.

陈华, 阙思伟, 易竟, 等. 开颅血肿清除术结合脑室外引流术治疗小脑出血的临床分析[J]. 中国社区医师, 2019, 35(17): 13-13

, 16.

KURAMATSU J B, BIFFI A, GERNER S T, et al. Association of surgical hematoma evacuation vs conservative treatment with functional outcome in patients with cerebellar intracerebral hemorrhage[J]. JAMA, 2019, 322(14): 1392-1403.

顾志成, 张明石, 杨军, 等. 后颅窝锥孔引流治疗小脑出血[J]. 黑龙江医药科学, 2012, 35(5): 45-45.

卓杰, 刘春生, 杨玉山, 等. 钻孔引流术与去骨瓣减压血肿清除术治疗小脑出血的疗效对比研究[J]. 中国现代神经疾病杂志, 2014, 14(6): 535-539.

魏恒, 张华, 张化明, 等. 钻孔引流术和开颅血肿清除术在小脑出血中的疗效比较[J]. 中国实用神经疾病杂志, 2015, 18(17): 40-41.

崔辛, 谢应朗. 后颅窝脑实质出血穿入脑室系统的CT研究[J]. 放射学实践, 2001, 16(5): 310-312.