Research Of The Correlation Between Decompression Window Design And Postoperative Subdural Effusion Of Hypertension Cerebral Hemorrhage Patients To Decompressive Craniectomy

Hypertensive cerebral hemorrhage(HICH)is one of the common complications of Hypertensive patients,HICH patients can suffer high blood pressure for a long-term,but the morbidity and mortality of HICH is high as a result of both Suddenly onset and location at parenchyma.The decompressive craniectomy has become an important treatment to treat hypertension cerebral hemorrhage with the rapid development of neurosurgery,some study shows,patients with hypertension cerebral hemorrhage surgery is obviously better than the medicine treatment.Although the decompressive craniectomy has obvious clinical advantages,the injury from operation is severe,is difficult to repair,is prone to secondary injury,is prone to suffer the complications,such as infection,hydrocephalus,postoperative subdural effusion,epilepsy etc.Subdural effusion is one of the common complications.If is can't be Discovered and dealt with in time,the patients will become worse.even endanger the life of patients.Some studies have confirmed the relationship between the decompressive craniectomy and subdural effusion.Its maybe cause by the injury in arachnoid during the decompressive craniectomy in the patients suffered from cerebral hemorrhage.There are lots of treatments to subdural effusion currently.Most of them are done after the subdural effusion happen.But prevention is always better than treatment.So.What we need to do is seeking an rational operation to reduce the subdural effusion.The aim of my research is arrival at a conclusion through the relationship between the design of the decompressive craniectiomy and the postoperative subdural effusion,and guide the design the window of the decompressive craniectiomy.Objective: The objective is to study the relativity between the design the window of the decompressive craniectiomy in HICH patients and the morbidity of subdural effusion.to explore whether we can improve patient prognosis and survival quality by reducing the iatrogenic factor of the effusion.Methods:1 Case collection: Select 38 HICH patients who was diagnosised by CT and was treated by the decompressive craniectiomy Between January 2014 and February 2017.Select 21 cases of them were suffered the subdural effusion after the decompressive craniectiomy 2 weeks as the observation group,select 17 cases of them else as the control group.38 cases are all in first-onset and exclude the following conditions.(1)vital signs of patients are unstable;(2)HICH may caused by AVM,aneurism,coagulation disorders;(3)Severe complication;(4)The cases cannot finish the examination after 2 weeks because death,transfer,and give up treatment etc.2 Compare the statistical difference between the morbidity of subdural effusion of two groups with the following conditions.(1)Have the ventricle bleeding or not;(2)With the treatment of drainage or not.(3)the distance between the edge of the window and the central line.(4)The height of decompression window.(5)The length of decompression window.(6)The area of decompression window.(7)Combined hydrocephalus or not.3 Rebuilt the skull and Falx cerebri with the CT DICOM file using the software AdwantageWorkstation4.6,measure the least distance between the edge of the decompression window to the Falx cerebri.4 Using software SPSS17.0 to analyze the data,Choose chi-square test analysis,it shows statistical difference when P<0.05.Results:1 The two groups of patients have no statistical significance in age,sex,the location and the volume of hemorrhage,they are comparable.2 It's easy to suffer the subdural effusion in the group of the height of decompression window is larger than 6 centimeters,see Pic.2.3 It's easy to suffer the subdural effusion in the group of the diameter of decompression window is greater than 8 centimeters,see Pic.3.4 The morbidity of subdural effusion reduce with the area of decompression window become smaller from 40 cm square(P<0.05);The morbidity of subdural effusion increase with the area of decompression window become larger from 50 cm square(P<0.05).5 The patients with hydrocephalus shows a higher morbidity of subdural effusion(P<0.05).Conclusions:1 Design the height of the decompression window less than 6 cm and the length of the decompression window less than 8 cm can reduce the morbidity of subdural effusion.2 The morbidity of subdural effusion is become less with the area of decompression window is smaller than 50 cm square;the morbidity of subdural effusion is become much less with the area of decompression window is smaller than 40 cm square;But the area of decompression window wouldn't smaller than it is without a enough decompresive effect.3 The patients with hydrocephalus shows a higher morbidity of subdural effusion.