摘要
目的 探讨颅内压（ICP）监测下控制性减压在软通道穿刺引流术治疗长期服用阿司匹林的高血压脑出血患者中的应用. 方法 前瞻性纳入自2013年2月至2017年2月入住湖州市第一人民医院神经外科的有阿司匹林长期服用史的87例高血压脑出血患者,依据患者意愿将患者分为对照组（43例）和治疗组（44例）.对照组采取常规软通道穿刺引流术治疗,治疗组在软通道穿刺引流术治疗基础上联合ICP监测下控制性减压,同时术后进行ICP监测管理. 结果 治疗组达到ICP目标值（15 mmHg）时的抽吸血肿量[（10.38±3.24） mL]约占初始血肿量的20％左右.治疗组血肿腔内引流管留置时间[（90.0±4.2）h]较对照组[（73.0±3.8）h]明显延长,血肿清除率[（80.0±1.2）％]较对照组[（91.0±1.9）％]明显降低,差异均有统计学意义（P＜0.05）.治疗组术后再出血、头皮渗液及颅内感染的发生率（11.4％、9.1％、4.5％）较对照组（34.9％、25.6％、11.6％）均明显降低,恢复良好率（77.3％）较对照组（60.5％）明显提高,死亡率（9.1％）较对照组（18.6％）明显降低,差异均有统计学意义（P＜0.05）. 结论 对于长期服用阿司匹林的高血压脑出血患者,ICP监测下控制性减压联合软通道穿刺引流术治疗可有效改善患者的生存质量及预后.
Objective To explore the application of controlled decompression under intracranial pressure （ICP） monitoring for the patients with hypertensive intracerebral hemorrhage and long-term aspirin use in the treatment with soft channel puncture and drainage.Methods This prospective study enrolled 87 patients with hypertensive intracerebral hemorrhage and long-term aspirin use from the Department of Neurosurgery,The First People＇s Hospital of Huzhou from February 2013 to February 2017.They were divided into a control group （43 cases） and a treatment group （44 cases） according to their wishes.The control group was treated by conventional soft channel puncture and drainage while the treatment group by controlled depression under ICP monitoring in addition to soft channel puncture drainage.Results In the treatment group,the volume ofhematoma aspiration （ICP） was （10.38±3.24） mL,accounting for about 20% of the initial hematoma.The time for retention of endovascular drainage tube in the treatment group （90.0±4.2 h） was significantly longer than that in the control group （73.0±3.8 h）,and the hematoma clearance rate in the treatment group （80.0%±1.2%） was significantly lower than that in the control group （91.0%± 1.9%） （P〈0.05）.The incidences of such postoperative complications as rebleeding,scalp leachate and intracranial infection （11.4%,9.1% and 4.5%,respectively） in the treatment group were significantly lower than in the control group （34.9%,25.6% and 11.6%,respectively） （P〈 0.05）.The recovery rate in the treatment group （77.3%） was significantly higher than in the control group （60.5%）;the mortality rate in the former （9.1%） was significantly lower than in the latter （18.6%） （P〈 0.05）.Conclusion For patients with hypertensive intracerebral hemorrhage and long-term aspirin use,controlled decompression combined with soft channel puncture drainage under ICP monitoring can effectively improve their quality of life and prognosis.
作者
阳建国
钟兴明
Yang Jianguo;Zhong Xingming(Department of Neurosurgery, The First People＇s Hospital of Huzhou, The First Affiliated Hospital to Huzhou University, Huzhou 313000, China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2018年第5期507-511,共5页
Chinese Journal of Neuromedicine
关键词
高血压脑出血
阿司匹林
颅内压监测
控制性减压
软通道穿刺引流术
Hypertensive cerebral hemorrhage
Aspirin
Intracranial pressure monitoring
Controlled decompression
Soi
channel puncture drainage
