微创颅内血肿清除术与保守疗法治疗高血压脑出血的疗效比较

Treatment of hypertensive cerebral hemorrhage with minimally invasive intracranial hematoma clearance or conservative treatment-a comparison study

目的比较微创颅内血肿清除术与保守疗法治疗高血压脑出血的疗效。方法将60例符合人选标准的高血压脑出血患者随机分为微创颅内血肿清除术（微创组）和内科保守治疗组（对照组）各30例。微创组患者在CT引导下行颅内血肿清除术治疗，保守组患者只进行内科传统的保守治疗，对比分析两种方法的治疗效果。结果微创组平均首次血肿清除率为（56．5±18．6）％，平均总清除率为（78．6±21．5）％。微创组患者的死亡率（10．0％）显著低于对照组（33．3％），差异有统计学意义（P〈0．05）；术后1个月微创组和对照组的神经功能评分分别为（13．1±9．8）分和（25．3±11．4）分，两组比较有显著差异（P〈0．05）；术后3个月微创组ADLⅠ～Ⅲ级者22例（73．3％），对照组中仅6例（20％），两组比较差异有统计学意义（P〈0．05）。结论与保守疗法比较，微创颅内血肿清除术能够有效治疗高血压脑出血，具有患者死亡率低、恢复较好的特点。

Objective To compare the efficacy of minimally invasive intracranial hematoma clearance and conservative treatment in the treatment of hypertensive cerebral hemorrhage. Methods 60 patients of hypertensive cerebral hemorrhage who met the inclusive criteria were randomly divided into minimally invasive intracranial hematoma clearance group （MI group） and conservative treatment group （control group） with each group of 30 patients. Patients in MI group were given minimally invasive intracranial hematoma clearance while patients in control group were given conservative treatment. Results The mean first hematoma clearance rate of MI group was （56.5 ± 18.6） % and the mean total clearance rate was （78.6 ± 21.5） %. The mortality rate of MI group was significantly lower than that of control group （ 10.0% vs 33.3% ,P 〈 0.05 ） ; One month after treatment, the neurological score was （ 13.1 ± 9.8 ） in MI group and （25.3 ± 11.4） in the control, which was significantly different（ P 〈0.05） ;22 patients （73.3%） reached ADL grade Ⅰ to Ⅲ in MI group,compared with 6 （20%） in the control 3 months after operation （ P 〈 0.05 ）. Conclusion Compared with the conservative treatment, minimally invasive intracranial hematoma clearance can effectively treat hypertensive cerebral hemorrhage with low morality and better recovery.