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脑血肿压力梯度法则及其对高血压性脑出血手术的影响。

The rule of brain hematoma pressure gradient and its influence on hypertensive cerebral hemorrhage operation.

机构信息

Department of Neurosurgery, Rizhao People's Hospital Affiliated With Jining Medical University, Rizhao, 276826, Shandong Province, People's Republic of China.

出版信息

Sci Rep. 2021 Feb 25;11(1):4599. doi: 10.1038/s41598-021-84108-w.

Abstract

To comparatively study the size of and variation in the 'brain-haematoma' pressure gradient for different surgical methods for hypertensive intracerebral haemorrhage (HICH) and analyse the gradient's influence on surgical procedures and effects of the haemorrhage. Seventy-two patients with HICH treated from 1/2019 to 12/2019 were randomly divided into two groups, namely, the keyhole endoscopy and large trauma craniotomy groups, according to different operative methods. Intraoperative changes in intracranial pressure (ICP) were monitored to calculate intraoperative alterations in the 'brain-haematoma' pressure gradient. Intraoperative characteristics (operative time, bleeding volume, volume of blood transfusion, and haematoma clearance rate) and postoperative characteristics (oedema, postoperative activities of daily living (ADL) scores, mortality rate and rebleeding rate) were compared between the two groups. In the keyhole endoscopy group, ICP decreased slowly; the 'brain-haematoma' pressure gradient was large, averaging 251.1 ± 20.6 mmHO, and slowly decreased. The mean operative time was 83.6 ± 4.3 min, the mean bleeding volume was 181.2 ± 13.6 ml, no blood transfusions were given, the average postoperative haematoma clearance rate was 95.6%, the rate of severe oedema was 10.9%, and the average postoperative ADL score was 85.2%. In the large trauma craniotomy group, ICP rapidly decreased after craniotomy. When the haematoma was removed, the 'brain-haematoma' pressure gradient was small, averaging 132.3 ± 10.5 mmH2O, and slowly decreased. The mean operative time was 232 ± 26.1 min, the mean bleeding volume was 412.6 ± 35.2 ml, the average volume of blood transfusion was 281.3 ± 13.6 ml, and the average postoperative haematoma clearance rate was 82.3%; moreover, the rate of severe oedema was 72.1%, and the average postoperative ADL score was 39.0%. These differences were statistically significant (P < 0.05). Neither the death rate (P > 0.05, 2.7% VS 2.8%) nor rebleeding rate (P > 0.05, 2.7% VS 2.8%) showed any obvious changes. The magnitude and variation in the 'brain-haematoma' pressure gradient for different surgical methods significantly influence surgical procedures and effects of HICH. During keyhole endoscopy surgery, this gradient was relatively large and slowly decreased; the haematoma was therefore easier to remove. Advantages of this approach include a high haematoma clearance rate, decreased bleeding volume, decreased operative time, reduced trauma, decreased postoperative brain oedema and improved postoperative recovery of neurological function.Chinese Clinical Trial Register: ChiCTR1900020655 registration in 12/01/02,019 registration in 28/02/02,020 Number: NCOMMS-20-08,091.

摘要

为了比较研究不同手术方法治疗高血压性脑出血(HICH)的“脑血肿”压力梯度的大小和变化,并分析梯度对手术的影响及出血的影响。选取 2019 年 1 月至 2019 年 12 月间收治的 72 例 HICH 患者,根据不同的手术方法分为锁孔内镜和大创伤开颅术两组。监测颅内压(ICP)的变化,计算术中“脑血肿”压力梯度的变化。比较两组患者的术中特征(手术时间、出血量、输血量、血肿清除率)和术后特征(水肿、术后日常生活活动(ADL)评分、死亡率和再出血率)。在锁孔内镜组中,ICP 缓慢下降;“脑血肿”压力梯度较大,平均为 251.1±20.6mmHg,且缓慢下降。平均手术时间为 83.6±4.3min,平均出血量为 181.2±13.6ml,未输血,平均术后血肿清除率为 95.6%,严重水肿发生率为 10.9%,平均术后 ADL 评分为 85.2%。在大创伤开颅组中,开颅后 ICP 迅速下降。当血肿被清除时,“脑血肿”压力梯度较小,平均为 132.3±10.5mmHg,且缓慢下降。平均手术时间为 232±26.1min,平均出血量为 412.6±35.2ml,平均输血量为 281.3±13.6ml,平均术后血肿清除率为 82.3%;此外,严重水肿的发生率为 72.1%,平均术后 ADL 评分为 39.0%。这些差异具有统计学意义(P<0.05)。死亡率(P>0.05,2.7%VS2.8%)和再出血率(P>0.05,2.7%VS2.8%)均无明显变化。不同手术方法的“脑血肿”压力梯度的大小和变化对手术方法和 HICH 的效果有显著影响。在锁孔内镜手术中,这个梯度相对较大,且缓慢下降;因此血肿更容易清除。这种方法的优点包括血肿清除率高、出血量减少、手术时间缩短、创伤小、术后脑水肿减轻、神经功能恢复改善。中国临床试验注册中心:ChiCTR1900020655 于 2019 年 12 月 1 日注册,2019 年 2 月 28 日注册,2020 年注册号:NCOMMS-20-08,091.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b960/7907243/0a331a002976/41598_2021_84108_Fig1_HTML.jpg

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