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Lingnan Modern Clinics in Surgery ›› 2019, Vol. 19 ›› Issue (05): 608-613.DOI: 10.3969/j.issn.1009-976X.2019.05.024

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Analysis of complications after Burr-hole craniostomy and drainage in 242 cases of hypertensive intracerebral hemorrhage

ZHUO Shaowei,SHI Shaochun, HUANG Liujun, LIN Xiaoyi, QIN Kangwei, ZHANGZhunyi,CAIShujia, ZHANG Shujia   

  1. Department of Neurosurgery, Lufeng People′s Hospital, Lufeng, Guangdong 516500
  • Contact: ZHANG Shujia

高血压脑出血引流术后再出血和感染的观察分析

卓少伟,师少春,黄柳军,林小义,秦康威,张准仪,蔡树嘉,张曙佳*   

  1. 陆丰市人民医院神经外科,广东陆丰516500
  • 通讯作者: 张曙佳

Abstract: Objective To analyze the causes and related factors of complications after operation of hypertensive intracerebral hemorrhage. Methods This was a retrospective analysis of 242 patients with hypertensive intracerebral hemorrhage who received minimally invasive burr-holecraniostomy and closed-system drainage (BCD) from August 2015 to September 2018. The efficacy, accuracy of catheter placement and the causes of complications such as catheter-related bleeding and infection were analyzed. Results Of the 242 patients, 114 had complications (47.1%). Among 16 patients with rebleeding and requiring intervention, 7 cases were treated with re-catheterization, 9 cases were treated with conservative medical treatment, and 3 cases died. The cause of rebleeding was associated with the use of aspirin and anticoagulants, but not with age, sex, emergency operation and Kakarla classification. There were 8 cases of catheter-drainage infection in this group, 6 of which caused focal intracerebral abscess, and the other 2 cases were scalp redness and abscess caused by pericatheter infection, which were cured after dressing change and anti-infection.Among all the patients, 28 were completely recovered, 175 were significantly improved and 16 were not improved. According to ADL classification, there were 147 cases Ⅰ~Ⅱ, 67 cases Ⅲ~Ⅳ, and 5 cases Ⅴ, and 11 cases died during admission and 12 cases died during follow-up to 6 months. Conclusion Patients with hypertensive intracerebral hemorrhage have a high incidence of complications after cranial trepanation and drainage. Rehaemorrhage and infection are important risk factors to be dealt with.

Key words: hypertensive intracerebral haemorrhage, complications, Burr-hole craniostomy and drainage

摘要: 目的 分析高血压脑出血术后并发症的原因和相关因素。方法 采用回顾性分析方法,纳入2015年8月至2018年9月期间所有高血压脑出血接受微创的颅骨钻孔导管引流(BCD)的患者共242例,分析疗效、导管放置的准确性以及导管相关出血和感染等并发症的发病和原因。结果 242例患者中,术后共114人次发生各类并发症(47.1%)。16例发生再出血并需要干预的患者中,经再次置管处理7例,9例采取内科保守治疗,3例死亡。再出血与使用阿司匹林及抗凝药物有关联,与手术时间有关;但与年龄、性别、急诊手术、Kakarla 分级无关。本组病例中共8发生导管引流管相关感染,其中6例引发颅内感染,2例导管周围感染导致头皮红肿和脓性分泌物,经抗感染、换药后痊愈。所有患者中,完全恢复28例,明显改善和改善患者175例,无改善者16例;按照ADL分级,Ⅰ~Ⅱ:147例,Ⅲ~Ⅳ:67例,Ⅴ:5例;入院期间死亡11例,随访到6月增加12例死亡。结论 高血压脑出血患者行颅骨钻孔引流术后并发症发生率高,再出血和感染是需要处理的重要危险因素。

关键词: 钻孔引流术, 并发症, 高血压脑出血

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