小骨窗与传统大骨瓣开颅血肿清除术治疗高血压脑出血的疗效比较

Comparison of efficacy of craniotomy hematoma evacuation with small and large bone flap in the treatment of hypertensive intracerebral hemorrhage

目的比较小骨窗与传统大骨瓣开颅血肿清除术治疗高血压脑出血的临床疗效。方法采用随机、对照临床试验方法。将2010-08—2013-08间96例高血压脑出血患者随机分为观察组和对照组,每组各48例。观察组进行小骨窗开颅血肿清除术;对照组进行与传统大骨瓣开颅血肿清除术。采用死亡率、手术时间、手术前后血肿清除率、住院时间及围手术期并发症对高血压脑出血术后的早期治疗效果进行评价,而根据日常生活能力(Activitiesof daily Living,ADL)分级法对高血压脑出血的远期疗效进行评价。结果围手术期观察组出现并发症7例(14.58%)显著少于对照组的15例(31.25%),差异有统计学意义(P<0.05);观察组和对照组的住院时间分别为(24.06±9.41)d和(15.30±6.35)d,组间比较有统计学意义(P<0.05),但在病死率、手术时间、手术前后血肿清除率和住院时间方面,两组差异无统计学意义(P>0.05)。在最近一次随访时,观察组和对照组ADL分级治疗效果恢复良好率分别为64.44%(29/45)和69.56%(32/46),组间比较差异有统计学意义(P>0.05)。结论相对于传统大骨瓣开颅血肿清除术,小骨窗血肿清除术治疗高血压脑出血的临床疗效相似,但手术创伤小,并发症少,值得基层医院推广。

Objective To compare the efficacy of craniotomy hematoma evacuation with small and large bone flap in the treatment of hypertensive intracerebral hemorrhage. Methods A randomized,controlled clinical trial. During Auguest 2010 and Auguest 2013,ninety- six patients with hypertensive intracerebral hemorrhage were randomized into experimental group and control group,forty- eight cases in each group. In experimental group,craniotomy hematoma evacuation with small bone flap was performed,and with large bone flap in control group.Early clinical efficacy were assessed by mortality,operating time,hematoma rate after surgery,hospital stay and peri- operative complication,and activities of daily living( ADL) were used to evaluated the long- term effect. Results Operations were successfully performed in all cases.there were 7cases( 14. 58%) with peri- operative complications in experimental group,significantly less than 15 cases( 31. 25%) in control group( P < 0. 05); And the hospital stay were( 24. 06 ± 9. 41) days and( 15. 30 ± 6. 35) days in experimental group and control group respectively,and there was significant differences between the two groups( P < 0. 05). Mortality,operating time and hematoma rate after surgery were no significant differences between the two groups( P > 0. 05). In the last follow up,the good- excellent recovery rate of ADL score were64. 44%( 29 /45) and 69. 56%( 32 /46),( 24. 06 ± 9. 41) days and( 15. 30 ± 6. 35) days in experimental group and control group respectively,and there was no significant differences between the two groups( P > 0. 05). Conclusion Craniotomy hematoma evacuation with small bone flap was similar in efficacy with large bone flap for the treatment of hypertensive intracerebral hemorrhage,and should be widely applied.