Comparative Study of Efficacy of Trepanation and Drainage and Bone Flap Craniotomy Hematoma Evacuation combined with Decompressive Craniectomy in the Treatment of Aspirin-related Supratentorial Cerebral Hemorrhage
SHEN Yu, XU Chunlin, CHENG Xiaozhi, et al
Huanggang Central Hospital, Hubei Huanggang 438000, China
AbstractObjective: To study the efficacy and safety of trepanation and drainage and bone flap craniotomy hematoma evacuation combined with decompressive craniectomy in the treatment of aspirin (ASA)-related supratentorial cerebral hemorrhage (SCH). Methods: 84 patients with ASA-related SCH in our hospital from September 2015 to September 2018 were selected and divided into trepanation group and craniotomy group according to the simple randomization method, with 42 cases in each group. Trepanation group was given trepanation and drainage, and craniotomy group was given small bone window craniotomy hematoma evacuation and decompressive craniectomy. The hematoma clearance rate, the NIHSS score, GCS score and GOS score at 24 h after operation, ability of daily living at 6 months after operation, incidence rate of postoperative complications and mortality rate of patients were compared between the two groups. Results: The operative time, intraoperative blood loss, drainage time and hospital stay in trepanation group were significantly lower than those in craniotomy group (P<0.05), and there was no significant difference in the hematoma clearance rate between the two groups (P>0.05). At 24h after operation, the NIHSS score in the two groups was significantly decreased (P<0.05) while the scores of GCS and GOS were significantly increased (P<0.05), and the NIHSS score in trepanation group was lower than that in craniotomy group while the scores of GCS and GOS were higher than those in control group (P<0.05). At 6 months after operation, the ability of daily living in trepanation group was significantly better than that in craniotomy group (P<0.05), and the excellent and good rate of ability of daily living in the two groups were 90.24% and 84.21% respectively (P>0.05). The incidence rates of complications in trepanation group and craniotomy group were 21.43% and 19.05% respectively (P>0.05), and the mortality rates were 2.38% and 4.76% respectively (P>0.05). Conclusions: Compared with craniotomy hematoma evacuation combined with decompressive craniectomy, trepanation and puncture drainage has simpler operation, smaller trauma and quicker postoperative recovery, and it can effectively reduce NIHSS score, enhance scores of GCS and GOS and improve postoperative daily living ability, and increase significantly the incidence rate of postoperative complications.
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2019, Vol. 25 
