小骨窗开颅与常规骨瓣开颅在高血压脑出血患者中的临床效果对比分析

Analysis of the clinical effect of small bone window craniotomy and conventional bone flap craniotomy in the treatment of patients with hypertension cerebral hemorrhage

目的对比分析小骨窗开颅与常规骨瓣开颅在高血压脑出血患者中的临床疗效。方法选择深圳市龙岗区第二人民医院2010年9月至2015年1月收治确诊的186例高血压脑出血患者。依据随机数字表法均分为两组,其中93例施行小骨窗开颅术(观察组),93例施行常规骨瓣开颅术(对照组),观察比较两组患者的手术时间、格拉斯哥预后量表(GOS)评分等指标。结果观察组术中输血量、手术时间、GOS评分及住院时间均明显优于对照组,差异具有统计学意义(P<0.01);两组患者住院治疗期间出血量≤50 ml者、出血量>50 ml者,高格拉斯哥昏迷量表(GCS)评分者、低GCS评分者病死率及总病死率比较差异不具有统计学意义(P>0.05);观察组恢复良好者68例(78.16%),明显优于对照组(52例,63.41%),差异具有统计学意义(P<0.05);观察组总的并发症发生率(11.83%)明显低于对照组(30.11%),差异具有统计学意义(P<0.01)。结论小骨窗开颅术在治疗高血压脑出血患者时与常规骨瓣开颅术相比,临床疗效显著,安全可靠,具有重要的临床价值。

Objective To compare the clinical efficacy of small bone window craniotomy with conventional bone flap craniotomy in the treatment of patients with hypertensive cerebral hemorrhage. Methods 186 cases of hypertensive cerebral hemorrhage patients treated in the Department of Neurosurgery, Longgang District Second People＇s Hospital from September 2010 to January 2015 were involved in this study. According to random number table method, all of patients were divided into two groups. 93 cases who were performed small bone window craniotomy treatment as observation group, 93 cases who were performed normal bone flap craniotomy treatment as control group. Operation time, Glasgow outcome scale（GOS） score, and other indicators were compared between the two groups. Results Intraoperative blood transfusion volume, operation time, GOS score and the length of hospital stay in observation group were significantly better than the control group, there were statistical differences（P〈0.01）. During hospitalization, there were no statistical significances on fatality rate and total mortality between the bleeding≤50 ml patients and bleeding50 ml patients, lower Glasgow coma scale（GCS） score patients and higher GCS patients（P〈0.05）. 68 cases（78.16%） recovered well in observation group, which was better than control group（52 cases, 63.41%）, there was statistical difference（P〈0.05）; The total complications in observation group（11 cases, 11.83%） was obviously lower than the control group（28 cases, 30.11%）, there was statistical difference（P〈0.01）. Conclusion Compared with conventional bone flap craniotomy surgery in the treatment of hypertensive cerebral hemorrhage patients, small bone window craniotomy has the characters of evident clinical effect, safe and reliable, and has important clinical value.