微创穿刺引流联合尿激酶治疗慢性硬膜下血肿的临床效果及短期预后观察
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摘要
目的探讨微创穿刺引流联合尿激酶治疗慢性硬膜下血肿(chronic subdural hematoma, CSDH)的临床效果及短期预后。方法选取2016年1月—2018年2月收治的86例CSDH,按照随机数字表法分为观察组和对照组,每组各43例。观察组予微创穿刺引流联合尿激酶治疗,对照组予常规椎颅置管引流术治疗。观察术后7 d的临床疗效,记录手术时间、血肿消失时间及住院时间,采用健康调查简易问卷量表(又称SF-36量表)评价治疗前、治疗半年后的生活质量,比较术后并发症发生情况及术后半年的血肿复发情况。结果观察组、对照组治疗总有效率分别为95.35%(41/43)、81.40%(35/43),比较差异有统计学意义(χ~2=2.508、P=0.028)。与对照组比较,观察组手术时间、血肿消失时间、住院时间均缩短,且治疗后SF-36量表各维度评分均升高,差异有统计学意义(P<0.05);与本组治疗前比较,两组治疗后SF-36量表各维度评分均升高,差异有统计学意义(P<0.05)。观察组嗜睡、颅内积气、硬膜下积液的发生率及血肿复发率均低于对照组,比较差异有统计学意义(P<0.05)。结论微创穿刺引流联合尿激酶治疗CSDH操作简单、创伤小,可有效提高血肿清除率,改善术后生活质量,减少并发症的发生,降低血肿复发率。
Objective To investigate the clinical effect and short-term prognosis of minimally invasive puncture and drainage combined with urokinase in the treatment of chronic subdural hematoma(CSDH). Methods Eighty-six cases of CSDH admitted from January 2016 to February 2018 were randomly divided into observation group and control group, with 43 cases in each group. The observation group was treated with minimally invasive puncture and drainage combined with urokinase, while the control group was treated with conventional conical catheterization and drainage. The clinical efficacy was observed 7 days after operation. The duration of operation, the time of hematoma disappearance and the length of hospitalization were recorded. The quality of life before and six months after treatment was assessed with Short Form 36 Health survey Questionnaire(also known as SF-36), and the incidence of complications after operation and the recurrence of hematoma six months after operation were compared. Results The total effective rates of the observation group and the control group were 95.35%(41/43) and 81.40%(35/43), respectively, with significant difference(χ~2=2.508, P=0.028). Compared with the control group, the duration of operation, hematoma disappearance time and length of hospitalization of the observation group were shortened, and the SF-36 score in the observation group was increased after treatment, with statistical significance(P<0.05). Compared with those before treatment, the scores of each dimension of the SF-36 in the two groups was increased after treatment, with statistical significance(P<0.05). The incidence of sleepiness, intracranial pneumatosis and subdural effusion as well as recurrence rate of hematoma in the observation group were lower than those in the control group, and the difference was statistically significant(P<0.05). Conclusion Minimally invasive puncture and drainage combined with urokinase in the treatment of CSDH is simpler and less invasive than conventional cone-cranial catheter drainage. It can effectively increase the clearance rate of hematoma, improve the quality of life of patients after operation, and reduce the occurrence of complications and recurrence rate of hemotoma.
Objective To investigate the clinical effect and short-term prognosis of minimally invasive puncture and drainage combined with urokinase in the treatment of chronic subdural hematoma(CSDH). Methods Eighty-six cases of CSDH admitted from January 2016 to February 2018 were randomly divided into observation group and control group, with 43 cases in each group. The observation group was treated with minimally invasive puncture and drainage combined with urokinase, while the control group was treated with conventional conical catheterization and drainage. The clinical efficacy was observed 7 days after operation. The duration of operation, the time of hematoma disappearance and the length of hospitalization were recorded. The quality of life before and six months after treatment was assessed with Short Form 36 Health survey Questionnaire(also known as SF-36), and the incidence of complications after operation and the recurrence of hematoma six months after operation were compared. Results The total effective rates of the observation group and the control group were 95.35%(41/43) and 81.40%(35/43), respectively, with significant difference(χ~2=2.508, P=0.028). Compared with the control group, the duration of operation, hematoma disappearance time and length of hospitalization of the observation group were shortened, and the SF-36 score in the observation group was increased after treatment, with statistical significance(P<0.05). Compared with those before treatment, the scores of each dimension of the SF-36 in the two groups was increased after treatment, with statistical significance(P<0.05). The incidence of sleepiness, intracranial pneumatosis and subdural effusion as well as recurrence rate of hematoma in the observation group were lower than those in the control group, and the difference was statistically significant(P<0.05). Conclusion Minimally invasive puncture and drainage combined with urokinase in the treatment of CSDH is simpler and less invasive than conventional cone-cranial catheter drainage. It can effectively increase the clearance rate of hematoma, improve the quality of life of patients after operation, and reduce the occurrence of complications and recurrence rate of hemotoma.
引文
[1] 王荣耀,王勇.慢性硬膜下血肿140例临床研究[J].中国临床医生杂志,2018,46(3):325-326.
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[12] 邹勇,顾应江,刘玉州,等.慢性硬膜下血肿的发病机制及治疗措施研究进展[J].世界最新医学信息文摘,2018,18(68):61-63.
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[15] 彭涛.分析慢性硬膜下血肿接受微创钻孔密闭引流术治疗的效果[J].中西医结合心血管病电子杂志,2018,6(16):59,62.
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[18] 景慎东,胡延霞,李宪峰.尿激酶在微创手术治疗慢性硬膜下血肿中的作用[J].中国临床神经外科杂志,2016,21(11):707-709.
[19] 林运全,郭大华,郑泽洲,等.YL-1型针引流联合尿激酶冲洗在慢性硬膜下血肿中的治疗效果[J].中国当代医药,2017,24(20):48-51.
[20] 姚军,吴崇光,王雷平,等.慢性硬膜下血肿钻孔引流术后复发危险因素分析[J].浙江创伤外科,2018,23(2):231-232.
[21] 胡杨杨,狄广福,徐宗华,等.慢性硬膜下血肿术后复发危险因素分析及防治策略[J].皖南医学院学报,2018,37(2):170-172,176.
[2] 白金鑫,王跃彬,陈宁,等.慢性硬膜下血肿的治疗研究进展[J].临床医药实践,2018,27(3):210-213.
[3] 胡杨杨,戴易.慢性硬膜下血肿治疗新策略[J].沈阳医学院学报,2018,20(2):174-177.
[4] 张富贵.微创穿刺针联合尿激酶治疗慢性硬膜下血肿疗效观察[J].青海医药杂志,2014,44(5):13-14.
[5] Herold J,Nowak S,Kostin S,et al.Factor VII activating protease (FSAP) influences vascular remodeling in the mouse hind limb ischemia model[J].Am J Transl Res,2017,9(6):3084-3095.
[6] 钟亮,钟敏.慢性硬膜下血肿的诊断及手术选择[J].中国社区医师(医学专业半月刊),2008,10(22):19.
[7] 许奕聪,王能强,林运全,等.微创穿刺引流联合尿激酶灌注治疗慢性硬膜下血肿患者的临床疗效观察[J].中国医学创新,2018,15(17):123-126.
[8] 李洪业.慢性硬膜下血肿30例治疗观察[J].中国保健营养,2018,28(30):113.
[9] 周劲,刘皇勇,冉庆国,等.慢性硬膜下血肿临床分析[J].激光杂志,2013,34(4):114-115.
[10] 宋志旺,祁震宇.慢性硬膜下血肿196例诊治[J].中国血液流变学杂志,2012,22(1):91-93.
[11] 权成峰,赵超.慢性硬膜下血肿引流术后并发症原因分析及防治措施[J].临床误诊误治,2012,25(1):89-91.
[12] 邹勇,顾应江,刘玉州,等.慢性硬膜下血肿的发病机制及治疗措施研究进展[J].世界最新医学信息文摘,2018,18(68):61-63.
[13] 王先堂.慢性硬膜下血肿发病机制与治疗进展[J].中国保健营养,2017,27(13):76.
[14] 翁晓波.微创锥孔引流治疗老年慢性硬膜下血肿临床观察[J].深圳中西医结合杂志,2018,28(8):155-156.
[15] 彭涛.分析慢性硬膜下血肿接受微创钻孔密闭引流术治疗的效果[J].中西医结合心血管病电子杂志,2018,6(16):59,62.
[16] 苗林,夏吉勇,李志强,等.微孔穿刺引流加尿激酶溶解治疗慢性硬膜下血肿的临床效果观察[J].中国医药指南,2018,16(9):2-3.
[17] 曲月波,温吉海,韩邦涛,等.尿激酶辅助引流治疗慢性硬膜下血肿的疗效观察[J].临床医药文献电子杂志,2017,4(64):12631.
[18] 景慎东,胡延霞,李宪峰.尿激酶在微创手术治疗慢性硬膜下血肿中的作用[J].中国临床神经外科杂志,2016,21(11):707-709.
[19] 林运全,郭大华,郑泽洲,等.YL-1型针引流联合尿激酶冲洗在慢性硬膜下血肿中的治疗效果[J].中国当代医药,2017,24(20):48-51.
[20] 姚军,吴崇光,王雷平,等.慢性硬膜下血肿钻孔引流术后复发危险因素分析[J].浙江创伤外科,2018,23(2):231-232.
[21] 胡杨杨,狄广福,徐宗华,等.慢性硬膜下血肿术后复发危险因素分析及防治策略[J].皖南医学院学报,2018,37(2):170-172,176.