神经内镜和显微手术治疗脑出血的疗效及卫生经济学比较

Comparison of efficacy and economic efficiency of neuroendoscope versus microscope for intracerebral hemorrhage

目的:研究神经内镜在脑出血血肿清除手术中的疗效和卫生资源利用情况。方法:回顾性分析我院2014年8月至2015年8月68例行脑出血手术患者的临床资料,其中显微血肿清除37例(显微镜组),内镜血肿清除31例(内镜组)。对两组患者手术相关指标(血肿清除率、手术出血量、手术时间、切口长度、骨窗面积)、术后6个月格拉斯哥结果评分、并发症(颅内感染、肺部感染、消化道出血)、卫生经济学指标(术后住院时间、药品费、非药品费、住院总费用)进行比较分析。结果 :内镜组手术出血量、手术时间、切口长度、骨窗面积均小于显微镜组(P<0.01),血肿清除率、术后6个月格拉斯哥结果评分优于显微镜组(P<0.05)。颅内感染、肺部感染内镜组小于显微镜组(P<0.05);消化道出血两组差异无统计学意义(P>0.05)。术后住院时间、药品费、非药品费、住院总费用方面,内镜组明显低于显微镜组,且差异具有统计学意义(P<0.01)。结论:神经内镜治疗脑出血具有创伤小、疗效好、预后佳、费用低的特点,值得临床推广应用。

Objective To investigate the differences of efficacy and economic efficiency between neuroendoscope and microscope for intracerebral hematomas cleaning operation. Methods From August 2014 to August 2015, clinical data of 68 cases with intraccrebral hemorrhage were analyzed retrospectively. Hematoma evacuation was carried out by microscope in 37 cases （microscope group） received and 31 cases （endoscope group） underwent neuroendoseope. Following parameters were compared： the operation related index （hematoma clearance rate, intraoperative blood loss, the operation time, skin incision, bone window size）, Glasgow Outcome Scale at 6 months after the operation, complications （intracrania） infection, lung infections, gastrointestinal bleeding）, medical economic parameters （the postoperative hospital stay, drug cost, cost other than drug, and total hospital cost）. Results The hematoma clearance rate, Glasgow Outcome Scale at 6 months after the operation in the endoscope group were significantly better than those in the microscope group （P 〈 0.05）. The intraoperative blood loss, the operation time, skin incision, bone window size the postoperative hospital stay, drug costs, no drug costs, and total hospital cost in the neuroendoseope group were significantly lower than those in the microscope group （P 〈 0.01 ）. The intracranial infection, lung infections in the neuroendoseope group were lower those in the microscope group （P 〈 0.05）. There was no statistical difference in the incidence of gastrointestinal bleeding between the two groups （P 〉 0.05）. The postoperative hospital stay, drug costs, no drug costs, and total hospital cost were significantly less in neuroendoscope group than that in microscope group （P〈 0.01）. Conclusion Neuroendoscopy has less trauma,there are some advantages of neuroendoscopy for intracerebral hematomas cleaning operation, such as minimal trauma, prominent effect, good prognosis and low cost. It should be widely applied in clinical practice.