方体定向双管软通道与小骨窗显微镜下开颅手术治疗中等量以上高血压脑出血对比研究

Comparative study on the treatment of moderate or equal volume hypertensive cerebral hemorrhage by craniotomy under square body directional double tube soft channel and small bone window microscope

目的探讨方体定向双管软通道与小骨窗显微镜下开颅手术治疗中等量以上高血压脑出血(HICH)的临床效果。方法按照随机数字表法将2021年9月1日-2023年9月1日赣南医学院第三附属医院收治的中等量以上HICH患者50例进行分组。对照组25例行小骨窗显微镜下开颅手术,观察组25例行方体定向双管软通道引流术。比较两组手术效果、临床相关指标、神经功能、生活自理能力、预后情况。结果观察组手术效果优于对照组,两组均未出现死亡病例,观察组并发症发生率4.00%(1/25)低于对照组的32.00%(8/25),差异有统计学意义(P<0.05)。观察组手术时间(64.37±10.87)min短于对照组的(98.49±13.11)min,血肿清除率(90.73±2.69)%高于对照组的(79.81±5.24)%,差异有统计学意义(P<0.05)。两组术前NIHSS、BI评分比较,差异无统计学意义(P>0.05);两组术后1个月NIHSS评分均降低,BI评分均升高,且观察组变化更明显,差异有统计学意义(P<0.05)。结论与小骨窗显微镜下开颅术相比,中等量以上HICH患者采用方体定向双管软通道引流术的效果更佳,操作时间更短,血肿清除率更高,并发症更少,利于神经功能、生活自理能力恢复,改善患者预后,值得临床广泛应用。

Objective To explore the clinical effect of square body oriented double tube soft channel and small bone window microscope assisted craniotomy in the treatment of moderate to high volume hypertensive intracerebral hemorrhage(HICH).Method Fifty patients with moderate to high levels of HICH admitted to our hospital from September 1,2021 to September 1,2023 were divided into groups using a random number table method.The control group received 25 cases of craniotomy under a small bone window microscope,while the observation group received 25 cases of square body oriented double tube soft channel drainage.Compare the surgical outcomes,clinical indicators,neurological function,self-care ability,and prognosis between two groups.Result The surgical effect of the observation group was better than that of the control group,and there were no deaths in either group.The incidence of complications in the observation group was 4.00%(1/25),which was lower than that in the control group(32.00%,8/25),and the difference was statistically significant(P<0.05).The surgical time of the observation group(64.37±10.87)minutes was shorter than that of the control group(98.49±13.11)minutes,and the hematoma clearance rate(90.73±2.69)%was higher than that of the control group(79.81±5.24)%,with a statistically significant difference(P<0.05).There was no statistically significant difference in preoperative NIHSS and BI scores between the two groups(P>0.05);both groups showed a decrease in one month after postoperative NIHSS and an increase in BI scores,and the observation group showed more significant changes,with a statistically significant difference(P<0.05).Conclusion Compared with craniotomy under a small bone window microscope,square directional double tube soft channel drainage is more effective for patients with moderate to large amounts of HICH,with shorter operation time,higher hematoma clearance rate,and fewer complications.It is beneficial for the recovery of neurological function and self-care ability,improves patient prognosis,and is worthy of widespread clinical application.