小骨窗开颅术治疗老年高血压脑出血临床研究

Clinical study of small bone window craniotomy in the treatment of aged hypertensive intracerebral hemorrhage

目的探讨小骨窗开颅术治疗老年高血压脑出血的临床效果。方法选取我院2012-06—2014-09收治的高血压脑出血患者64例,随机分成2组,对照组行常规骨瓣清除术,实验组实施小骨窗开颅术,对比2组临床疗效、手术时间、住院时间、术中出血量、神经功能缺损评分及并发症发生情况。结果实验组总有效率(96.88%vs 75.00%)明显高于对照组,差异有统计学意义(P<0.05);2组术前神经功能缺损评分(40.50±5.67vs 40.85±7.00)比较差异无统计学意义(P>0.05),但实验组术后7、14、28d神经功能缺损评分(23.46±6.37vs 27.04±7.70;17.62±6.07vs 21.46±8.41;12.08±5.31vs 20.74±6.94)较对照组低(P<0.05);实验组手术时间(45.11±9.17vs 115.16±18.75)、住院时间(17.25±4.55vs23.44±5.64)、术中出血量(52.42±9.32vs 185.12±12.45)均低于对照组,差异有统计学意义(P<0.05);实验组并发症发生率(18.74%vs 53.13%)显著低于对照组,差异有统计学意义(P<0.05)。结论小骨窗开颅术治疗老年高血压脑出血临床疗效优于常规骨瓣清除术,安全指数高,应引起足够重视。

Objective To investigate the clinical effect of small bone window craniotomy in treating aged hypertensive intracerebral hemorrhage.Methods 64 patients with hypertensive intracerebral hemorrhage in our hospital from June 2012 to September 2014 were selected.They were divided into two groups,control group was given removal of conventional bone flap and observation group was given small bone window craniotomy.The clinical effect,operation time,hospital stay,intraoperatve blood soss,NIHSS and complication occurrence situation of the two groups were compared.Results The total efficiency of observation group was obviously higher than that of control group（96.88% vs 75.00%）,the difference was statistically significant（P〈0.05）.The NIHSS score of the two groups before treatment（40.50±5.67 vs 40.85±7.00）had no significant difference（P〉0.05）.After treatment of 7th,14 th and 28 th day,NIHSS of observation group was lower than that of control group（23.46±6.37 vs 27.04±7.70;17.62±6.07 vs 21.46±8.41;12.08±5.31 vs 20.74±6.94）（P〈0.05）.Operation time（（45.11±9.17）minutes vs（115.16±18.75）minutes）,hospital stay（（17.25±4.55）days vs（23.44±5.64）days）,and intraoperative amount of bleeding of observation group were obviously lower than those of control group（（52.42±9.32）mL vs（185.12±12.45）mL）,the differences were statistically significant（P〈0.05）.Complication occurrence rate of observation group was obviously lower than that of control group（18.74% vs 53.13%）,the difference was statistically significant（P〈0.05）.Conclusion The application of small bone window craniotomy in treating aged hypertensive intracerebral hemorrhage has better clinical effect than removal of conventional bone flap.Safety index is higher and it is worthy of clinical application.