CAJ | 학술논문

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。
목적：탐토개로술여찬공인류술치료고혈압뇌출혈（HICH）후로내압적영향，위림상HICH후선택합리적수술치료제공의거。방법선택HICH환자120례，수궤분위개로조（n=60）화찬공조（n=60），개로조채용개로수술치료，찬공조채용찬공인류술결합뇨격매용해술치료，비교량조환자술후즉시、24h、72h화1주시로내압변화정황。결과량조환자술후즉시로내압균증고，술후72h체봉치，술후1주개시하강。개로조로내압재각시간점균저우찬공조（P＜0.05）。결론개로수술치료HICH재강저로내압력，감소뇌조직손해방면우우찬공인류술。단개로수술유우존재창상대등결점，인차응재술전종합고필환자전신상황、출혈부위、혈종량등인소，재선택합괄적술식，단불관하충술식，균이강저뇌출혈환자병사、병잔솔，개선생존질량위최종목적。
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.