小骨窗开颅术与骨瓣开颅术治疗高血压脑出血疗效比较

A comparative study of therapeutic effects of small bone flap craniotomy and traditional craniotomy in patients with hypertensive cerebral hemorrhage

目的对小骨窗开颅术与骨瓣开颅术治疗高血压脑出血的疗效进行比较。方法将从化市中心医院自2008年6月至2010年6月收治的56例高血压脑出血患者按随机数字表法分入观察组（行小骨窗开颅术，28例）与对照组（行骨瓣开颅术，28例），比较两组患者手术时间、住院时间、住院期间病死率、再出血发生率、并发症发生率及治疗后半年GOS评分。结果观察组手术时间及住院时间明显短于对照组，差异有统计学意义（P〈0．05）；观察组与对照组住院期间病死率分别为14_3％、25．0％，差异无统计学意义（P〈0．05）；观察组与对照组并发症发生率分别为25．0％、46．4％，差异无统计学意义（P〈0．05）：观察组治疗半年后GOS评估预后明显优于对照组，差异有统计学意义（P〈0．05）；观察组与对照组再出血发生率分别为10．7％、14.3％，差异无统计学意义（P〉0．05）。结论与骨瓣开颅术相比，小骨窗开颅术治疗高血压脑出血能明显降低病死率及并发症发生率，改善患者预后。

Objective To explore the therapeutic effects of small bone flap craniotomy and traditional craniotomy in patients with hypertensive cerebral hemorrhage. Methods Fifty-six patients with hypertensive cerebral hemorrhage, admitted to our hospital from June 2008 to June 2010, were randomly divided into experimental group （treated with small bone flap craniotomy, n=28） and control group （treated with traditional craniotomy, n=28）. The operative time, hospital stays, case fatality rate, re-bleeding and complications and Glasgow outcome scale scores after 6 months treatment were analyzed and compared between the 2 groups. Results Operation time and hospital stays of the patients in the experimental group were significantly shorter than those in the control group （P〈0.05）. The case fatality rate was 14.3% and 25.0% in the experimental group and control group, respectively, without significant differences （P〈0.05）; the incidence of complications was 25.0 % and 46.4 % in the 2 groups without significant differences （P〈0.05）; the scores of Glasgow outcome scale in the experimental group were superior to those in the control group （P〈0.05）; the rate of re-bleeding was 10,7 % and 14.3 % in the 2 groups without significant difference （P〉0.05）. Conclusion As compared with traditional craniotomy, small bone flap craniotomy can decrease the rate of case fatality and complications, and improve the prognosis in patients with hypertensive cerebral hemorrhage.