小骨窗颅内血肿清除术治疗高血压性脑出血的临床观察

Clinical Observation on the Effect of Small Bone Window for Removal of Intracranial Hematoma in the Treatment of Hypertensive Cerebral Hemorrhage

目的比较小骨窗颅内血肿清除术与微创穿刺血肿抽吸术治疗高血压性脑出血的临床疗效及安全性。方法选择符合标准的患者50例,随机分为观察组和对照组各25例,观察组应用小骨窗颅内血肿清除术,对照组应用微创穿刺血肿抽吸术,比较二者近期及远期临床疗效。结果观察组手术时间(56.22±8.20)min,长于对照组的(16.73±4.28)min,差异有统计学意义(P<0.05);观察组术后24 h血肿清除率(85.49±7.03)%、住院时间(20.16±3.49)d,对照组为(56.31±5.79)%、(26.82±5.50)d,差异有统计学意义(P<0.05)。术前观察组NIHSS评分(11.46±3.53)分,对照组(11.52±3.67)分,差异无统计学意义(P>0.05);术后2周及4周观察组NIHSS评分(6.14±3.20)分、(3.42±1.92)分,对照组为(8.25±3.11)分、(5.30±2.75)分,二者NIHSS评分较术前均下降(P<0.05),但是观察组下降幅度更大,差异有统计学意义(P<0.05)。观察组ADL评价I级5例、II级8例、III级6例、IV级3例、V级2例和死亡1例,对照组ADL评价I级3例、II级5例、III级8例、IV级5例、V级3例和死亡2例,差异有统计学意义(P<0.05)。观察组并发症发生率40.00%,与对照组的44.00%相似,差异无统计学意义(P>0.05)。结论小骨窗颅内血肿清除术治疗高血压性脑出血,可有效清除颅内血肿,促进神经功能恢复,提高临床治疗效果。

Objective To compare the clinical efficacy and safety between small bone window for removal of intracranial hematoma and minimally invasive evacuation of intracranial hematoma in the treatment of hypertensive cerebral hemorrhage. Methods 50 el-igible patients were selected and randomly divided into observation group and control group, with 25 patients in each group. The observation group used small bone window for removal of intracranial hematoma, while the control group used minimally invasive evacuation of intracranial hematoma. And the short-term and long-term clinical efficacies were compared between the patients of the two groups. Results The operative time of the observation group was （56.22±8.20） min, longer than the control group＆#39;s （16.73± 4.28） min, the difference was statistically significant （P〈0.05）; The hematoma clearance rate within 24h after the operation in the observation group was （85.49±7.03）%, the length of stay was （20.16±3.49） d, and that of the control group was （56.31±5.79）%, （26.82±5.50） d, respectively, the difference was statistically significant （P〈0.05）. Before operation, The NIHSS score was （11.46± 3.53） points in the observation group, and that was （11.52±3.67） points in the control group, the difference was not statistically sig-nificant （P〉0.05）;The NIHSS score of the observation group 2, 4 weeks after the operation was （6.14±3.20） points, （3.42±1.92） points, respectively, and that of the control group was （8.25±3.11） points, （5.30±2.75） points, respectively, the NIHSS scores of both groups decreased compared with those before operation （P〈0.05）, but the observation group had a larger decline, the difference between the groups was statistically significant （P〈0.05）. By the ADL evaluation, in the observation group, there were 5 cases with grade I, 8 cases with grade II, 6 cases with grade III, 3 cases with grade IV, 2 cases with grade V, 1 case died, in the control group, there were 3 cases with grade I, 5 cases with grade II, 8 cases with grade III, 5 cases with grade IV, 3 cases with grade V, 2 cases died, the difference was statistically significant （P〈0.05）. The incidence of complications of the observation group was 40.00%, similar to 44.00%of the control group, the difference was not statistically significant （P〉0.05）. Conclusion Small bone window for removal of intracranial hematoma in the treatment of hypertensive cerebral hemorrhage can effectively remove the intracranial hematoma, promote the rehabilitation of nerve function, and elevate the clinical efficacy.