不同外科治疗方法治疗高血压脑出血的疗效比较研究

Comparative Study on Different Methods of Surgical Treatment of Hypertensive Cerebral Hemorrhage

目的探讨应用不同外科治疗方法治疗高血压脑出血的疗效,从而为高血压脑出血的外科治疗如何合理选择手术方式和手术时机提供进一步的参考依据。方法将2008年1月～2010年1月在我院及浙江省人民医院神经外科住院进行手术治疗的68例高血压脑出血患者作为观察对象,其中36例应用小骨窗开颅术,设立为观察组,32例应用传统大骨瓣开颅术,设立为对照组,回顾性分析68例高血压脑出血患者的临床资料,应用统计学方法从以下方面进行对比研究:术后两组的ADL分级疗效情况、治疗后不同时间两组神经功能缺损评分变化情况、两组术后并发症发生率情况、两组术后血肿清除率及死亡率情况。结果①与对照组比较,观察组的Ⅰ～Ⅲ级别的恢复良好率为83.3%(30/36),明显高于对照组62.5%(20/32)(P<0.05)。②两组治疗后2周及4周的神经功能缺损评分均较治疗前明显改善,且观察组较对照组改善更明显(P<0.05)。③两组并发症发生率比较,差异无统计学意义(P>0.05)。④术后两组的血肿清除率比较差异不显著,但观察组术后死亡率明显低于对照组(P<0.05)。结论小骨窗开颅术与大骨瓣开颅术各具优缺点,临床医生需根据适应证选择合理的手术方式进行手术。

Objective To evaluate different surgical methods treatment hypertensive cerebral hemorrhage, which is the surgical treatment of hypertensive cerebral hemorrhage on how a reasonable choice of surgical approach and timing of surgery for further reference. Methods There were 68 patients with hypertensive cerebral hemorrhage as the object of observation from January 2008 to January 2010 in our hospital, 36 patients were treated with a small bone window craniotomy, the establishment of the observation group, 32 patients were treated with traditional large trauma craniotomy, the establishment of the control group, retrospective analysis of 68 cases of hypertensive cerebral hemorrhage clinical data, the application of statistical methods were compared from the following aspects： （1） The ADL classification after two treatment conditions ; （2） Two different times after treatment of neurological deficit score changes; （3） The incidence of postoperative complications; （4） Postoperative hematoma rate and mortality rates. Results （1） With the control group to observe the group I - III level of good recovery rate was 83.3% （30/36）, significantly higher than 62.5%（20/32）（P 〈 0.05）. （2） After treatment, 2 weeks and 4 weeks of neurological deficit score was significantly improved compared with before treatment, and the observation group than in the control group improved more significantly （P 〈 0.05）. （3） The incidence of complications in both groups, the difference was not statistically significant（P 〉 0.05）. （4） Rate of postoperative hematoma compared the two groups was not significant, but the observation of postoperative mortality was significantly lower than the control group （P 〈 0.05）. Conclusion The small bone window craniotomy with large trauma eraniotomy each with advantages and disadvantages, clinicians need to choose the right according to the surgical indications for surgery.