穿刺引流术对脑出血后脑水肿及预后的影响

目的探讨基底节高血压脑出血后穿刺引流术和药物保守洽疗对脑水肿及预后的影响。方法基底节高血压脑出血患者62例，随机接受经额叶血肿穿刺引流术（微创组）或单纯药物治疗（对照组）。分别于治疗第3和14天时评价治疗前后血肿和脑水肿体积改善程度、再出血发生率、血肿完全吸收时间，以及微创组患者血肿引流时间、血肿清除率、手术后并发症和手术安全性。结果住院期间两组患者均未发生再出血，对照组有6例患者（20％）于治疗开始3d内因严重脑水肿致脑疝形成改行开颅血肿清除术，微刨组穿刺引流术后无一例发生穿刺相关性脑出血、颅内感染及死亡。微创组患者血肿完全吸收时间（7．41±5．84）d]短于对照组（23．15±8．49）d]，差异具有统计学意义（t=9．897，P=0．000）。治疗第3天时两组患者脑水肿体积比较，对照组（58．42±11．56）ml]明显大于微创组（8．47±7．76）ml]，差异有统计学意义（t=20．242，P=0．000）；治疗后6个月时，两组患者预后良好率比较，微创组（30例，93．75％）优于对照组（20例，66．67％；P=0．007）。结论穿刺引流术可减轻脑出血后脑水肿程度，具有促进患者神经功能恢复的良好作用。

Effects of craniopuncture and drainage of intracerebral hemorrhage on brain edema and neurological outcome

Objective To investigate the effects of craniopuncture and drainage for the treatment of intracerebral hemorrhage on brain edema and neurological outcome. Methods A total of 62 hypertensive patients with basal ganglia hematoma were selected. These patients were randomly divided into minimally invasive group （n = 32） and medical treatment group （n = 30）. Patients of minimally invasivc group were treated by craniopuncture and drainage through frontal approach. After surgery patients were given basic treatment： hemostatic agents, antibiotics, dehydration, hypertensive control and nutritive support. Patients of medical treatment group were only treated with medicine. An image process software was used to measure the volume of hematoma and brain edema. The difference in rebleeding rate, time course of complete clot absorption, brain edema volume on the first day and the third day and neurological outcome were compared between the 2 groups. Drainage time, percentage of clot removal and surgery complications were recorded to evaluate the safety of minimally invasive surgery. Results There was no rebleeding case in the 2 groups. Clot evacuation by craniectomy was performed on 6 patients （20%） in medical treatment group for severe brain edema and cerebral herniation in the first 3 d. Time course of complete clot absorption in minimally invasive group （7.41 ±5.84） d] was significantly lower than the medical treatment group （23.15 ±8.49） d; t = 9.897, P = 0.000]. On the third day edema volume in medical treatment group （58.42 ±11.56） roll was significantly higher than the minimally invasive group （8.47 ±7.76） ml; t = 20.242, P = 0.000]. No cases of puncture-related bleeding, infection and death were found in the minimally invasive group. The favorable outcome rate in minimally invasive group was 93.75% （30/32）, significantly higher than 66.67% （20/30） in the medical treatment group at 6 months later （P = 0.007）. Conclusion The craniopuncture and drainage of intracerebral hematoma could reduce the degree of brain edema after intracerebral hemorrhage and improve neurological outcome.