The Clinical Application Of Swift Pore (Minimally Invasive) Drilling Cranial Drainage In Severe Hypertensive Intracerebral Hemorrhage

ObjeetiveResearch swift pore (minimally invasive) drilling cranial nerve surgery in Severe Hypertensive Intracerebral Hemorrhage and evaluate its clinical value.MethodsWe analyzed retrospectively clinical data of 236 patients of Severe Hypertensive Intracerebral Hemorrhage (Awareness of the situation after cerebral hemorrhage grade IV-V class, GCS≤9 points) from 2002 to 2009 in Qianfoshan Hospital in Shandong Province. And follow the surgical procedure were divided into groups and craniotomy group drilling, drilling under local anesthesia group rapid pore (minimally invasive) drilling drainage surgery, craniotomy group anesthesia and hematoma evacuation, which groups 163 drilling cases, craniotomy group of 73 patients; before surgery the relevant factors that may affect the efficacy such as gender, age, history of hypertension, hematoma locationand hematoma volume and time from onset to surgery were statistically analyzed; operation time were compared; after 1 day,7 days,14 days,30 days, review head CT evaluation of intracranial cases, evaluation after 1 month Glasgow Outcome Scale GOS, and statistically compare mortality and rebleeding, sugar and electrolyte metabolism disorders, pulmonary infection, intracranial infection and other major complications.Results1. Operation time:drilling group (8.7±3.9) minutes, significantly less than the craniotomy group (136.5±19.6) minutes.2. Comparison of postoperative complications:①drilling group were 55 cases of pulmonary infection (33.7%); craniotomy group of 35 patients (47.9%); drilling group than craniotomy group.②drilling group were high blood sugar metabolism of water and electrolyte balance disorders and 49 cases (30.1%); craniotomy in 31 cases (42.5%); drilling group than craniotomy group.③drilling group were 15 cases of intracranial infection (9.2%),; Craniotomy 6 patients (8.2%),; two groups was not significant difference.④drilling group were 17 patients with rebleeding (10.4%); craniotomy 8 patients (11%); the two groups was not significant difference.3. Comparison of curative effect: 1 month after surgery, the recent efficacy between patients with relatively small hematoma(basal ganglia≤60ml, cerebral lobes≤60ml, cerebellum≤15ml), drilling was better than craniotomy groups. Large hematoma volume(basal ganglia 60-90ml, basal ganglia≥90ml, cerebral lobes 60-90ml, cerebral lobes≥90ml, cerebellum>15ml) in patients with cranial drilling group showed no significant group differences. Brainstem hemorrhage hematoma in patients with a routine cavity drainage hole,4 hole routine lateral drainage, GOS3 points in 2 cases (40%); 2 points 1 case patients (20%); 1 point 2 cases (40%).4. the death of patients after 1 month (GOS= 1):Drilling group 57 patients died (35.0%), the cause of death analysis:14 cases died of postoperative bleeding, disease continues to progress after the death of 21 cases, multiple organ failure in 22 cases of death; craniotomy group of 28 patients (38.4%), the cause of death analysis:6 died of postoperative bleeding, disease continues to progress after the death of 11 cases, multiple organ failure and 11 died. Two overall mortality was not statistically different; basal ganglia hemorrhage, lobar hemorrhage, cerebellar hemorrhage compared with different amount of bleeding is not statistically different between; brain stem hemorrhage and 2 cases died (40%).ConclusionSwift pore (minimally invasive) drilling skull craniotomy drainage method and compared to the required simple equipment, without anesthesia, trauma, operating fast:①drilling operation time was less than craniotomy group;②drilling postoperative pulmonary infection and high blood sugar and water electrolyte metabolism disorder in the incidence of lower cranial group; postoperative intracranial infection and re-bleeding was no difference between patients and craniotomy;③drilling group basal ganglia, cerebral lobes and cerebellar hematoma volume in patients with smaller Recent effective than craniotomy group, large hematoma volume was no difference between patients and craniotomy; brain stem hemorrhage in patients with severe disability after January 2 (40%); plants in 1 (20%); death 2 cases (40%);④drilling group and the craniotomy group overall mortality and basal ganglia hemorrhage, lobar hemorrhage, cerebellar hemorrhage was no different to compare differences in blood loss.