两种术式治疗高血压性脑出血的临床效果比较分析

Comparative Analysis on the Clinical Effect of Two Surgical Treatments for Hypertensive Intracerebral Hemorrhage

目的探讨小骨窗开颅显微镜下血肿清除术与传统骨瓣血肿清除术治疗高血压性脑出血的临床疗效。方法选择2009年6月至2012年10月在北京华信医院暨清华大学第一附属医院神经外科就诊的高血压性脑出血患者80例作为观察对象。按随机数字表法分为观察组和对照组。比较两组入院及术后1个月格拉斯哥昏迷量表(GCS)评分、术后3个月ADL评分、术后血肿清除率、术后并发症发生率、术后再出血、病死率及临床疗效。结果观察组临床疗效优于对照组,两组临床疗效比较差异有统计学意义(P<0.05);观察组术后1个月GCS评分为(12.6±2.3)分,对照组术后1个月GCS评分为(9.1±1.8)分,两组比较差异有统计学意义(P<0.01);观察病死率及术后3个月采用日常生活活动能力方面均显著优于对照组(P<0.05)。结论小骨窗开颅显微镜下血肿清除术手术时间短,操作简便,治疗高血压性脑出血临床疗效好,值得临床推广使用。

Objective To explore the clinical effect of microsurgery through small skull window and traditional decompressive craniectomy in treating hypertensive intracerebral hemorrhage. Methods A total of 80 cases of patients with hypertensive intracerebral hemorrhage admitted in Department of Neurosurgery, Beijing Huaxin Hospital and the First Hospital Affiliated to Tsinghua University from Jun. 2006 to Oct. 2012, and divided into small skull window microscopic removal group （ the observation group ） and decompressive craniectomy group（ the control group） according to the random number table. The GCS scores on admission and 1 month after operation, ADL scores at 3 months after operation, the postoperative hematoma clearance rate, the incidence of postoperative complications, the postoperative recurrence of hemorrhage, the mortality and clinical effect of the two groups were compared. Results Clinical curative effect of tbe observation group was superior to that of the control group, the difference was statistically significant （ P 〈 0. 05 ） ; the GCS score at 1 month after operation of the observation group was（ 12.6 ± 2.3 ） ,while that of the control group was （9. 1 ± 1.8 ）, with statistically significant difference （ P 〈 0.01 ）. The incidence of postoperative complications,mortality,the ADL scores at 3 months after operation of the observation group were all better than those of the control group, with statistically significant difference （ P 〈 0.05 ）. Conclusion Microsurgery through small skull window has the advantages of short operation time, simple operation and good clinical efficacy in the treatment of hypertensive cerebral hemorrhage, therefore, it is worthy of being recommended in clinical practice.