显微镜下锁孔开颅颅内血肿清除术和软通道微创引流术治疗高血压脑出血的临床疗效观察

Clinical Observation of Microscopically Keyhole Craniotomy for Intracranial Hematoma Evacuation and Soft Channel Minimally Invasive Drainage in the Treatment of Hypertensive Intracerebral Hemorrhage

目的探讨显微镜下锁孔开颅颅内血肿清除术和软通道微创引流术治疗高血压脑出血(HICH)的效果。方法选择2023年1—11月本院收治的128例HICH患者为研究对象,按随机数字表法将其分为锁孔开颅组(n=64)和软通道微创组(n=64)。锁孔开颅组行显微镜下锁孔开颅颅内血肿清除术治疗,软通道微创组行软通道微创引流术治疗。对比两组血肿清除率、生活能力、神经功能、意识状态、氧化应激指标和并发症发生情况。结果锁孔开颅组血肿清除率为89.06%,软通道微创组血肿清除率为84.38%,两组比较,差异无统计学意义(P>0.05)。术后,两组美国国立卫生研究院卒中量表(NIHSS)评分低于术前,日常生活能力评分量表(ADL)评分高于术前,且锁孔开颅组ADL评分高于软通道微创组,NIHSS评分低于软通道微创组,差异有统计学意义(P<0.05)。术后,两组超氧化物歧化酶(SOD)水平、格拉斯哥昏迷量表(GCS)评分均高于术前,丙二醛(MDA)水平低于术前,且锁孔开颅组SOD水平、GCS评分均高于软通道微创组,MDA水平低于软通道微创组,差异有统计学意义(P<0.05)。锁孔开颅组术后并发症总发生率低于软通道微创组,差异有统计学意义(P<0.05)。结论两种术式治疗HICH效果均较好,但显微镜下锁孔开颅颅内血肿清除术后患者应激反应轻,减少并发症发生,且可更好地改善患者神经功能、意识状态,提高日常生活能力。

Objective To investigate the effect of microscopically keyhole craniotomy for intracranial hematoma evacuation and soft channel minimally invasive drainage in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods 128 patients with HICH admitted to our hospital from January to December 2023 were selected as the research objects and randomly divided into a keyhole craniotomy group(n=64)and a soft channel minimally invasive group(n=64).The keyhole craniotomy group was treated with microscopic keyhole craniotomy for intracranial hematoma removal,and the soft channel minimally invasive group was treated with soft channel minimally invasive drainage.Hematoma clearance rate,living ability,neurological function,consciousness state,oxidative stress index and complications were compared between the two groups.Results The hematoma clearance rate of keyhole craniotomy group was 89.06%,and that of soft channel minimally invasive group was 84.38%,with no statistical difference between the groups(P>0.05).The National Institutes of Health Stroke Scale(NIHSS)score of the two groups after operation were lower than those before operation,and the(Activities of Daily Living)ADL score of the two groups were higher than those before operation,while the ADL score of the keyhole craniotomy group was higher than that of the soft channel minimally invasive group,and the NIHSS score of the keyhole craniotomy group was lower than that of the soft channel minimally invasive group,and the differences were statistically significant(P<0.05).After operation,the level of superoxide dismutase(SOD)and Glasgow Coma Scale(GCS)score in the two groups were higher than those before operation,and the level of malondialdehyde(MDA)was lower than that before operation,while the detection value of SOD and GCS score in the keyhole craniotomy group were higher than those in the soft channel minimally invasive group,and the detection value of MDA in the keyhole craniotomy group was lower than that in the soft channel minimally invasive group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the keyhole craniotomy group was lower than that in the soft channel minimally invasive group,and the difference was statistically significant(P<0.05).Conclusion Both surgical methods have good therapeutic effects on HICH,but patients with intracranial hematoma after microsurgical keyhole craniotomy have mild stress response,reduce the occurrence of complications,and better improve their neurological function,consciousness state,and daily living ability.