改良两点定位骨孔导向软通道微创介入治疗高血压性脑出血临床研究

摘要

目的:研究应用改良两点定位骨孔导向软通道微创介入体位液化血肿清除术治疗高血压性脑出血的疗效及超早期置双管手术再出血的危险性.方法:治疗组 在CT片改良两点定位下,建立骨孔导向预通道,微创介入体位液化血肿清除术治疗96例高血压性脑出血患者.同时选择同期应用硬通道技术治疗92例作为对照组,并随访3个月.治疗组超早期手术中置单管30例,置双管35例.结果:治疗组与对照组出院后3个月生存能力比较,治疗组死亡10例,对照组死亡22例,死亡率减少有统计学意义(X2=6.06,P<0.05);恢复良好率与效果不良率比有显著差别(X2=12.93,P<0.01);治疗组平均残余血肿量明显少于对照组,平均残余血肿量具有显著性差异,(t=10.93,P<0.01);治疗组平均拔管时间明显短于对照组,差异显著,(t= 6.87,P<0.01).超早期置双管比置单管手术再出血减少,差异显著(X2=4.93,P<0.05).结论:改良两点定位骨孔导向技术能精确置管,体位(头位)液化及最佳抽吸时机的选择能短时间内彻底清除血肿,降低病死率及致残率,双管穿刺引流能有效地减低超早期手术再出血的风险.%Objective: To study the therapeutic efficacy of liquefied hematoma drainage by soft channel minimally invasive intervention posture through improved 2-point bone hole orientation as well as the risk of rebleeding in ultra-early placement of twin tubes for hematoma removal. Method: 96 cases of patients with hypertensive intracerebral hemorrhage in the treatment group received the liquefied hematoma removal by minimally invasive intervention through the bone-hole guided channel under improved 2-point orientation in CT imaging; 92 cases in the control group received the hard-channel therapy over the same period; they were followed up for 3 months; in the treatment group, 30 cases were subject to the ultra-early placement of single tubes and 35 cases twin tubes. Result: In the comparison between the treatment group and the control group regarding survival of 3 months, 10 cases died in the front and 22 cases in the latter, so the mortality reduction was statistically significant ( X2 = 6.06, p <0. 05 ); there was a significant difference in good recovery rate and poor effect rate ( X2 = 12. 93 , P<0. 01 ); average residual hematoma amount was significantly less in the treatment group than in the control group, so being significantly different ( t = 10. 93 , p <0. 01 ); average tube removal time was significantly shorter in the treatment group than in the control group, and the difference was significant ( t = 6. 87, p <0.01 ). Rebleeding was less in ultra-early of twin tubes than in single, and the difference was significant ( X2 =4. 93, p <0. 05 ). Conclusion: Bone-hole guidance through improved 2-point orientation can accurately place tubes. Posture ( head ) liquefying and best suction timing choice can fully remove the hematoma in a short time, reduce mortality and morbidity. The twin-tube puncture and drainage can effectively reduce the risk of rebleeding in the ultra-early surgery.