开颅术与钻孔引流术治疗高血压脑出血后颅内压的影响比较

目的：探讨开颅术与钻孔引流术治疗高血压脑出血（HICH）后颅内压的影响，为临床HICH后选择合理的手术治疗提供依据。方法选择HICH患者120例，随机分为开颅组（n=60）和钻孔组（n=60），开颅组采用开颅手术治疗，钻孔组采用钻孔引流术结合尿激酶溶解术治疗，比较两组患者术后即时、24h、72h和1周时颅内压变化情况。结果两组患者术后即时颅内压均增高，术后72h达峰值，术后1周开始下降。开颅组颅内压在各时间点均低于钻孔组（P＜0.05）。结论开颅手术治疗HICH在降低颅内压力，减少脑组织损害方面优于钻孔引流术。但开颅手术由于存在创伤大等缺点，因此应在术前综合考虑患者全身状况、出血部位、血肿量等因素，再选择合适的术式，但不管何种术式，均以降低脑出血患者病死、病残率，改善生存质量为最终目的。

Comparison of effects of intracranial pressure after being treated hypertensive cerebral hemorrhage with craniotomy and drainage

ObjectiveTo investigate the effects of intracranial pressure after being treated hypertensive cerebral hemorrhage（HICH）with craniotomy and drainage,to provide clinical basis forreasonable selection of operation in HICH.Methods 120 HICH patients were selected and randomly divided into craniotomy group（n=60）and drilling group（n=60）,craniotomy group were treated with craniotomy operation,drilling group were treated with trepanation and drainage combined with urokinase dissolved,the intracranial pressure changes at postoperative instant,24 hours,72 hours and 1 weeks between two groups were compared.ResultsThe patients＇ intracranial pressure at postoperative instant increased in two groups,at postoperative 72 hours reached the peak,began to decline at postoperative 1 week. The intracranial pressure at each time point in craniotomy group were lower than that in drilling group（P〈0.05）. ConclusionTreating HICH with surgicalo peration can reduced intracranial pressure,reduce the damage to the brain tissue,its effect is better than that in drilling group.But craniotomy operation is due to presence of trauma defects,and therefore the patients’ systemic conditions,hemorrhage position,hematoma volume and other factors should be considered before operation.and then choose a suitable operation,but no matter what kind of operation,its ultimate goal is reduce the patients’ mortality,cerebral hemorrhage rate of disability,improve his quality of life.