微创穿刺血肿引流术与小骨窗血肿清除术及常规方法治疗老年高血压脑出血的疗效比较

The efficacy of minimally invasive hematoma drainage,small bone window hematoma and conventional treatment of hypertensive intracerebral hemorrhage

目的比较微创穿刺血肿引流术、小骨窗血肿清除术及常规治疗高血压脑出血的临床疗效。方法选择老年高血压性脑出血患者108例,采用随机数字表法将其分为三组各36例。常规组给予常规传统开颅血肿清除术,小骨窗组给予小骨窗血肿清除术,引流术组给予微创血肿穿刺引流术,在治疗后对三组临床疗效进行对比,在治疗1个月后用美国国立卫生研究院制定的卒中量表(NIHSS)对三组患者神经功能缺损进行评定对比,用Zung抑郁自评量表(SDS)对患者抑郁情况进行评定对比。结果引流组与小骨窗组血肿残留发生率分别为11.1%和8.3%,明显低于常规组55.6%,差异有统计学意义(P<0.05),但引流组与小骨窗组比较差异无统计学意义(P>0.05);小骨窗组再出血发生率5.6%明显低于引流组的16.7%和常规组的22.2%,差异有统计学意义(P<0.05),引流术组与常规组比较差异无统计学意义(P>0.05)。引流术组与小骨窗组治疗后NIHSS评分别为(11.9±2.7)分和(12.3±3.1)分,明显低于对照组,差异有统计学意义(P<0.05);引流术组与小骨窗组术后抑郁发生率分别为13.9%、16.7%,均明显低于常规组的33.3%,差异有统计学意义(P<0.05);对各组患者的NIHSS和SDS评分进行分析可知,治疗后NIHSS评分与SDS评分呈正相关关系(r=0.891、0.857,P<0.05)。结论对老年高血压性脑出血患者而言,应用微创穿刺引流术及小骨窗血肿清除术进行治疗,均能较好地促进其神经功能恢复,而且术后卒中抑郁发生率较低,因此值得在临床中应用。

Objective To compare the effect of minimally invasive hematoma drainage,small bone window hematoma and conventional treatment of hypertensive cerebral hemorrhage. Methods 108 older patients with hypertensive intracerebral hemorrhage admitted to hospital were included into this study. All patients were randomly divided into drainage law group,a small bone window for each group and the conventional group. The clinical efficacy of 36 cases in the treatment of the three groups were compared after 1 month of treatment. The study applied the U. S.National Institutes of Health stroke Scale（ NIHSS） as the criteria for the three groups of patients with neurological deficits. All patients were evaluated compared with the Zung self- Rating Depression scale（ SDS） for the comparative assessment of the situation in patients with depression. Results Relatively small differences in bone window rebleeding group were found. The difference was significantly lower than the number of cases occurring drainage group and the conventional group. The residual number of cases of drainage group and small bone window hematoma occurred was significantly lower than the conventional group. The difference was statistically significant（ P 〈 0. 05）. The NIHSS assessment of after drainage group and small bone window treatment group was（ 11. 9 ± 2. 7） points and（ 12. 3 ± 3. 1） points,which were significantly lower than the control group. The difference was statistically significant（ P〈 0. 05）. The postoperative incidence of depression of drainage group and small bone window was 13. 9%,16. 7%,33. 3%,which was significantly lower than the conventional group. The difference was statistically significant（ P〈 0. 05）. The NIHSS scores and SDS analysis,NIHSS score after treatment of each patient positively correlated with SDS score（ r = 0. 891,0. 857,P 〈 0. 05）. Conclusion In elderly patients with hypertensive intracerebral hemorrhage,the application of minimally invasive puncture,drainage and small bone window hematoma treatment can better promote their neurological recovery,and lower incidence of depression after stroke. This method is worthy of clinical application.