微创手术治疗外伤性颅内血肿临床疗效分析

Clinical analysis of minimally invasive surgical treatment of traumatic intracranial hematoma

目的探讨微创血肿清除术对外伤性颅内血肿的临床疗效及预后的影响。方法纳入神经外科符合入选标准的80例外伤性颅内血肿病人,分为颅内血肿微创治疗组(微创组,n=40)与常规手术组(开颅组,n=40),以两组患者的住院时间、住院费用进行成本效益比较,以术后并发症的发生率、术后2周GCS评分比较意识水平,以及术后2周NIHSS评分情况比较短期疗效,以术后90天Barthel指数比较远期疗效。结果微创组术后并发症发生率小于开颅组,微创组术后48小时内清醒者18例;开颅组术后48小时内清醒者9例,微创组的清醒时间显著短于开颅组;微创组术后2周NIHSS评分及术后90天Barthel指数评价神经缺损程度均优于开颅组(均P<0.05);微创组平均住院时间较短,并且住院费用少于开颅组。结论微创手术是治疗颅内血肿的重要手段,手术创伤小,血肿清除较满意,能明显缩短病人住院时间,节约医疗资源,并促进术后神经功能康复。

Objective To explore the effect of minimally invasive hematoma removal on traumatic intracranial hematoma. Methods 80 patients with traumatic intracranial hematoma were divided into intracranial hematoma minimally invasive treatment group （minimally invasive group, n=40） with conventional surgery group （craniotomy group, n =40）. The hospital time and hospitalization costs were observed. The cost-effectiveness, the incidence of postoperative complications, GCS score 2 weeks after operative, NIHSS score and 90 d Barthel index were evaluated. Results The gender, age, blood loss, preoperative GCS score and NIHSS score were no statistical difference between the two groups （P〉0.05）. The incidence of postoperative complications of minimally invasive group was less than that of craniotomy group. The waking time of minimally invasive group was significantly shorter than that of craniotomy group. The NIHSS score and postoperative 90 d Barthel index minimally invasive group were superior to that of craniotomy group （P〈0.05）. The minimally invasive group had shorter average hospital stay and less hospital costs than that of craniotomy group. Conclusion Minimally invasive surgery is an important means of treatment of intracranial hematoma, which can obviously shorten the hospitalization time, save resources, and promote postoperative neurologic recovery.