神经内镜手术对高血压脑出血患者的治疗效果

Effect of neuroendoscopic surgery on basal ganglia hemorrhage in patients with hypertensive intracerebral hemorrhage

目的研究神经内镜手术对高血压脑出血患者的治疗效果。方法选取2018年9月-2021年9月期间的HICH患者70例,根据手术方式的不同分为观察组34例和对照组36例,其中观察组使用神经内镜手术治疗,对照组采用传统开颅血肿清除术治疗,对比两组患者术后近期疗效、远期疗效、不良反应发生情况、并分析患者出血量与手术疗效之间的相关性。结果观察组术后一个月内的疗效最终有效率为91.17%,高于对照组69.44%,差异对比具统计学意义(P<0.05)。观察组术后半年内的疗效最终有效率为91.17%,对照组最终有效率为66.66%,观察组术后半年内的疗效最终有效率更高,差异对比具统计学意义(P<0.05)。观察组术后再出血1人、多器官感染1人、应激性溃疡2人,并发症发生率11.76%;对照组术后再出血2人、多器官感染6人、应激性溃疡3人、心律失常2人,并发症发生率36.11%。观察组并发症发生率低于对照组,差异对比具统计学意义(P<0.05);观察组的骨窗大小、手术时间、术前出血量、术时出血量等参数均要小于对照组,且近期疗效91.17%,高于对照组69.44%,差异对比具统计学意义(P<0.05);将单因素指标纳入多因素Logistic回归分析得出,骨窗大小过大、手术时间过长、术前出血量大、术时出血量大均为影响患者的治疗效果危险因素(P<0.05)。术前出血量及术时出血量与患者近期疗效和远期疗效均呈现负相关关系(r=-0.215,P=0.001;r=-0.433,P=0.001;r=-0.471,P=0.001;r=-0.409,P=0.001)。结论神经内镜手术在治疗HICH患者方面对比传统开颅手术来在手术时间和控制术时出血量等方面具有明显优势,而且术后并发症概率也更低,但本实验为单中心小样本研究,干扰因素较多,需要更进一步的数据研究来对研究结论进行证实,临床术式的选择还需结合病人实际情况以及医生的手术经验进行择优选择。

Objective To study the correlation between basal ganglia hemorrhage and the efficacy of surgery endoscopic neurosurgery(SEN)in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 70 patients with HICH from September 2018 to September 2021 were selected and randomly divided into an observation group(n=34)treated with SEN,and a control group(n=36)treated with traditional craniotomy hematoma evacuation.The short-term efficacy,long-term efficacy and adverse reactions were compared between the two groups,and the relationship between blood loss and surgical efficacy was analyzed.Results The final effective rate within one month after operation in the observation group was 91.17%,higher than 66.66%in the control group(P<0.05).The final effective rate within 6 months after operation in the observation group was 91.17%,higher than 66.66%in the control group(P<0.05).In the observation group,there was 1 case of rebleeding,1 case of multiple organ infection and 2 cases of stress ulcer were identified with incidence rate of complications of 11.76%;in the control group,there were 2 patients with rebleeding,6 patients with multiple organ infection,3 patients with stress ulcer and 2 patients with arrhythmia were identified with incidence rate of complications of 36.11%.The incidence rate of complications in observation group was lower than that in control group(P<0.05).The bone window size,operation time,preoperative blood loss,intraoperative blood loss and other parameters in observation group were less than that in the control group,and the short-term efficacy was 91.17%,higher than 69.44%in the control group(P<0.05).The univariate indicators included in multivariate logistic regression analysis showed that excessive bone window size,long operation time,large preoperative blood loss and large intraoperative blood loss were all risk factors affecting the treatment effect of patients(P<0.05).Conclusion Excessive bone window size,long operation time,large preoperative blood loss,large intraoperative blood loss and other factors are all risk factors affecting the effect of surgical treatment,which can be controlled to improve the effect of surgical treatment in clinical treatment.