大骨瓣开颅血肿清除术、小骨窗显微血肿清除术和钻孔血肿抽吸引流术治疗高血压脑出血临床疗效对比观察

A comparative study on clinical efficacy of large craniotomy for hematoma elimination,small bone microscopic window hematoma elimination and drilling hematoma aspiration and drainage in treatment of hypertensive intracerebral hemorrhage

目的探讨大骨瓣开颅血肿清除术、小骨窗显微血肿清除术和钻孔血肿抽吸引流术三种不同手术方式治疗高血压脑出血的疗效对比。方法选择高血压脑出血患者共108例;分别采用大骨瓣开颅血肿清除术(A组,42例)、小骨窗显微血肿清除术(B组,32例)、钻孔血肿抽吸引流术(C组,34例),对比观察治疗结果。结果 A组手术时间、术中出血量、住院时间均显著高于B组和C组(P<0.05)。A组患者肺部感染、应激性溃疡、肾衰竭发生率显著高于B组和C组(P<0.05)。B、C组术后2周GOS评分为优的患者比率显著高于A组,A组在术后2周GOS评分为差的患者比率显著高于B、C组(P<0.05)。三组术后6个月ADL评分中C组总有效率最高,显著高于A组和B组(P=0.012)。结论与大骨瓣开颅血肿清除术和钻孔血肿抽吸引流术相比,小骨窗显微血肿清除术与钻孔血肿抽吸引流术治疗高血压脑出血患者效果更好,并发症少,预后更佳,值得临床应用。

Objectiye To explore the comparative efficacy of large craniotomy for hematoma elimination,small bone microscopic window hematoma elimination and drilling hematoma aspiration and drainage in treatment of patients with hypertensive intracerebral hemorrhage. Methods A total of 108 patients with hypertensive cerebral hemorrhage were included in this study. Forty two patients performed large craniotomy for he-matoma elimination were listed in group A,32 patients performed small bone microscopic window hematoma elimination were allocated in group B, 34 patients with drilling hematoma aspiration and drainage were allocated in group C,and results of their treatment were compared. Results The operating time,amount of blood loss,duration of hospital stay in patients of group A were significantly higher than those of patients in groups B and C（ P 〈 0. 05）. Pulmonary infection,stress ulcer and renal failure in patients of group A were significantly higher than those of patients in patients of groups B and C,and the difference in proportion of GOS scores in patients of group A after 2 weeks of operation were significantly higher than those of patients in groups B and C（ P 〈 0. 05）. The total scores of ADL in patients of group C at 6 months after the operation were the maximum, and they were significantly higher than those of patients in group B and group C（ P = 0. 012）. Conclusion In comparison with large craniotomy hematoma elimination and drilling hematoma aspiration and drainage,the small bone microscopic window hematoma elimination and drilling hema-toma aspiration and drainage in treatment of patients with hypertensive intracerebral hemorrhage have better results with fewer complications and better prognosis,hence they are worthy to be clinically applied.