两种开颅血肿清除术治疗高血压脑出血疗效比较

Effective comparison of two craniotomies in treatment of hypertensive cerebral hemorrhage

目的比较标准骨瓣开颅血肿清除术与小骨窗开颅血肿清除术治疗高血压脑出血的疗效。方法将86例高血压脑出血患者,根据血肿大小分成两组,对大血肿组40例患者均采用标准骨瓣开颅血肿清除术,中等血肿组46例患者均采用小骨窗开颅血肿清除术。结果两组患者术后近期病死率、颅内再次出血率、肺部感染率比较,差异无统计学意义(P>0.05),而消化道出血率、格拉斯哥昏迷评分(GCS)比较,差异有统计学意义(P<0.05)。远期病死率、GCS评分、神经功能恢复率、日常生活能力分级(ADL)均无差异(P>0.05)。结论根据患者出血量的大小和病情采用骨瓣开颅血肿清除术或小骨窗开颅血肿清除术是治疗高血压脑出血两种重要手段。

Objective To compare the efficacy of the standard bone flap hematoma craniotomy evacuation and small bone window hematoma craniotomy evacuation in the treatment of hypertensive cerebral hemorrhage.Methods According to the size of hematoma,86 patients with hypertensive cerebral hemorrhage were divided into two groups.The large hematoma group（40 cases） adopted standard craniotomy evacuation of hematoma and the moderate hematoma group（46 cases） was treated by small bone window craniotomy evacuation of hematoma.Results The postoperative short-term mortality rate,intracranial rebleeding,pulmonary infection had no statistical difference between the two groups（P0.05）,while there were with statistical difference in gastrointestinal bleeding rates and the Glasgow Coma Scale（GCS） between these two groups（P0.05）.There were no statistical differences in long term mortality rate,GCS,nerve function recovery rate and activities of daily living（ADL） classification between the two groups（P0.05）.Conclusion Bone flap hematoma craniotomy evacuation and small bone window hematoma craniotomy evacuation are two important means to treat hypertensive cerebral hemorrhage.Adopting either of these two methods should be selected according to the bleeding volume and patients′ condition