微创钻孔引流术联合加速康复外科理念在脑出血治疗中的应用

Application of Minimally Invasive Drilling and Drainage combined with Enhanced Recovery After Surgery program in the treatment of cerebral hemorrhage

摘要:

目的 研究探讨微创钻孔引流手术联合加速康复外科（ERAS）理念在高血压脑出血患者治疗中的临床效果。方法 选取2019年4月—2020年6月该院收治的高血压脑出血（出血量30~50 mL）患者80例，采用随机数表法分为传统围手术期组（微创钻孔引流手术加传统围手术期方案）和ERAS围手术期组（微创钻孔引流手术加ERAS理念方案），各40例，记录两组患者术后不良反应、并发症及血清学指标等情况。结果 ERAS围手术期组的颅内感染、肺部感染和尿路感染发生率低于传统围手术期组（P<0.05）。与传统围手术期组相比，ERAS围手术期组患者监护室住院时间更短，住院费用降低（P<0.05）。ERAS围手术期组的Barthel指数（BI）评分和欧洲卒中量表（ESS）评分均优于传统围手术期组（P<0.05）。ERAS围手术期组术后第3天的C-反应蛋白（CRP）和白细胞介素-6（IL-6）水平低于传统围手术期组（P<0.05）。两组的手术切口愈合情况、手术时间及术后再出血方面差异无统计学意义（P>0.05）。结论 微创钻孔引流联合ERAS理念能减少患者术后应激，可加快恢复速度，减少脑出血患者的并发症，安全有效。

Abstract:

Objective To investigate the clinical effect of minimally invasive drilling and drainage combined with enhanced recovery after surgery program in patients with cerebral hemorrhage.Methods Eighty patients with hypertensive cerebral hemorrhage (within 30~50 ml hemorrhagic volume) from April 2019 to June 2020 were collected. The patients were divided into traditional group (minimally invasive drilling and drainage combined with traditional perioperative program, 40 cases) and ERAS group (minimally invasive drilling and drainage combined with enhanced recovery after surgery program, 40 cases) according to random number table method. Differences in recovery and complications were compared between these two groups after surgery.Results The incidence of intracranial infection and lung infection urinary tract infection in ERAS group was significantly lower than those in traditional group, and the differences were statistically significant (P<0.05). Compared to the traditional group, the time of patients staying in hospital was shorter and the hospital costs reduced in ERAS group (P<0.05). The Barthel Index score and European Stroke Scale score in the ERAS group was better than that in the traditional group (P<0.05). The time of patients staying in hospital in ERAS group was significantly shorter than that in traditional group (P<0.05). The Inflammation indexes of CRP and IL-6 on days 3 after surgery were lower in the ERAS group than the traditional group (P<0.05).There was no significant difference in the status of Surgical incision healing between the two groups (P>0.05).Conclusions Minimally invasive drilling and drainage combined with enhanced recovery after surgery program can accelerate recovery and reduce complications in the treatment of patients with cerebral hemorrhage, which is safe and effective for clinical application.