小骨窗与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效分析

Efficacy of Small Bone Window Craniotomy and Large Bone Flap Craniotomy in the Treatment of Hypertensive Cerebral Hemorrhage

目的:探讨小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术治疗高血压脑出血的疗效。方法:选取120例高血压脑出血患者,分为两组,对照组(60例)给予大骨瓣开颅血肿清除术,观察组(60例)给予小骨窗开颅血肿清除术。观察并记录患者围手术期指标,术前术后6个月神经功能缺损情况,术后6个月生活能力及随访12个月期间并发症、死亡例数情况,对比两种手术方法治疗高血压脑出血的疗效。结果:经小骨窗开颅血肿清除术治疗,观察组患者手术时间,术中输血量,住院时间均明显短于或少于采用大骨瓣开颅术治疗的对照组患者(P<0.05),但两组患者在血肿清除率上相比,差异没有统计学意义(P>0.05)。术前两组NIHSS评分相比,差异没有统计学意义(P>0.05)。术后6个月,两组NIHSS评分均明显降低,且观察组分值更低(P<0.05),术后6个月,观察组ADL评分为17.24±3.52,对照组ADL评分为22.73±5.67,观察组ADL评分明显低于对照组(P<0.05)。随访期间,两组死亡率相比较,差异没有统计学意义(P>0.05);并发症发生率方面相比较,观察组更低(P<0.05)。结论:小骨窗开颅血肿清除术对高血压脑出血具有较好的治疗效果,手术创伤小,神经功能影响小,能提高患者生活能力,术后并发症较少,值得临床推广使用。

Objective： To discuss the efficacy of small bone window craniotomy and large bone flap craniotomy in the treatment of hypertensive cerebral hemorrhage. Methods： 120 patients with hypertensive cerebral hemorrhage were selected, and they were randomly divided into two groups. The observation group（60 cases） was given small bone window craniotomy. The control group（60 cases）was given large bone flap craniotomy. The clinical efficacy was evaluated by perioperative indicators, neurological deficit situation before and after 6 months surgery, living ability and complications and death during 12 months follow-up. Results： After treated by small bone window craniotomy, the surgical time, intraoperative blood transfusion volume, hospitalization of the observation group were shorter and less than that of the control group（P〈0.05）. But there were no statistical significance on hematoma clearance rate between two groups（P〈0.05）. There were no statistical significance on NIHSS score between two groups before surgery（P〈0.05）. After 6 months surgery, the NIHSS score of two groups were decreased（P〈0.05）. And the NIHSS score of the observation group was lower than that of the control group（P〈0.05）. After 6 month surgery, the ADL score of observation group was 17.24±3.52, and the ADL score of control group was 22.73±5.67, and the ADL score of the observation group was significantly lower than that of the control group（P〈0.05）. During the follow-up period, there were no statistical significance on the mortality between two groups（P〉0.05）. The complications rate of the observation group was lower than that of the control group（P〈0.05）. Conclusions： The small bone window craniotomy has a good therapeutic effect on the hypertensive cerebral hemorrhage with small trauma and little postoperative complications, which can improve good improvement the living ability and has no great effect on nerve function, worthy of the clinical use.