Curative Effect Contrast Between Rapid Pore Cranial Drilling And Small Bone Window Surgery Treating Hypertension Intracerebral Hemorrhage Of The Old

Background:Hypertension cerebral hemorrhage is a common disease in older adults, Mortality and morbidity are high. There is an important signifycance to explore the effective treatment methods. Rapid pore cranial drilling and small bone window surgery both have less trauma than large trauma craniotomy, which are widely used in surgery treatment of cerebral hemorrhage. About the curative effect of two operation methods for treating highblood pressure cerebral hemorrhage is controversial,including bleeding site,blood loss, preoperative consciousness, age, which may be the important factors influencing surgical effect.Objective:To compare the clinical curative effect of the two surgeries treat the moderate doses (30-60ml) intracerebral hemorrhage of the old.Methods:.Clinical data were analyzed retrospectively of102elderly hypertension cerebral hemorrhage cases from Shandong province hospital, Qilu hospital of shandong university, from January2009to October2011,all cases meet the following requirements:having the exact history of hypertension; Bleeding site was located in basal ganglion, hematoma quantity30to60ml;Preoperative consciousness Ⅱ-Ⅳ classification; had no cerebral hernia preoperatively. All cases were divided into drilling group and small bone window group according to the operation method. Comparable analysis were done between two groups of patients with age, the bleeding, preoperative consciousness, the operation time and classification of prognosis. Rapid pore cranial drilling hematoma drainage were done under local anesthesia, through the frontal puncture to the central place of hematoma, hematoma cavity placed12or14silicon tube. Group of patients which had chosen smallbone window surgery in general anesthesia hematoma was cleared through the temporal lobe. Two groups of patients are given mannitol contraling cranial pressure, blood pressure control, blood sugar control, antibiotics to prevent infection etc. after admission, lumbar puncture were done to release hemorrhagic cerebrospinal fluid, and dealing with various kinds of complications, the early functional rehabilitation exercise as early as possible. Compare the incidents of the operative time, and postoperative hematoma clearance to bleed again, intracranial infection, and pulmonary infection, upper gastrointestinal bleeding, electrolytes disturbance between the two sets of patients. Compare postoperative14and30days in Scandinavia stroke scale to assess patients recent neural function recovery. Patents were followed up6months, according to the ADL rating of the long term recovery to assess patients.Results:1. The drilling operation time was significantly lower than the average of small bone window group (P<0.001); After one day small bone window group hematoma clearance better than drilling group (P<0.001), but when drawing the tube drilling group increased obviously, both the hematoma clearance was not statistically significant differences(P=0.898).2. The incidence of pulmonary infection, gastrointestinal bleeding, electrolytes disturbance of drilling group is below small bone window group (P<0.05); After the bleeding was no significant difference between the two groups (P=0.055), but there is a trend that the small bone drilling group lower than small bone window group; incidence of intracranial infection is no statistical differences (P=0.675).3. The two groups of14postoperative days SSS score was not statistically different (P=0.147). Drilling group of30days after surgery scores higher than small bone window group (P=0.034).4.6months after drilling the ADL rating is better than the whole of small bone window group (P=0.015). For the ADL I level of recovery of the patients, drilling group is more than small bone window group (P=0.020)Conclusion:1. Rapid pore cranial drilling consuming shorter time, don’t need general anesthesia, fast and minimally invasive, the hematoma clearance not as good as small bone window craniotomy group postoperative1day, but through the urokinase therapy, When drawing tube the two group counterparts.2. Drilling group has lower incidence in pulmonary infection, electrolyte imbalance complications, Long term prognosis of patients with overall better than small bone window surgery group, proportion of patients restore to ADL level I is smaller than small bone window surgery group.3. For the basal ganglia hypertension cerebral hemorrhage volume30to60ml, which had not yet occurred with cerebral hernia of elderly patients can be first consider rapid pore cranial drilling drainage. Scandinavia stroke scale to assess patients recent neural function recovery postoperative14and30days. Patients were followed up6months, according to the ADL rating of the long term recovery to assess patients.