不同引流方案治疗大量基底节区高血压脑出血患者的疗效对比

Comparison of curative effect of hypertensive cerebral hemorrhage patients of different drainage treatment of large basal ganglia

【目的】比较研究超早期微创穿刺引流术、额后部入路锥颅血肿穿刺抽吸引流术和小骨窗CT引导下钻孔引流术对于基底节区高血压脑出血患者的临床疗效。【方法】选择2015年1月至2016年1月本院收治的基底节区高血压脑出血患者90例，所有对象按照严格随机分组原则分为超早期微创穿刺引流术（A组）、额后部入路锥颅血肿穿刺抽吸引流术（B组）和小骨窗CT引导下钻孔引流术（C组）各30例。对比分析三组患者术后血肿吸收情况、神经功能缺失评分（NIHSS评分）、日常生活能力评分（ADL评分）和术后并发症情况等。【结果】A组血肿大小显著低于B组和C组患者血肿大小，差异有统计学意义（P〈0．05）；A组血肿完全吸收时间显著短于B组舜口C组，差异有统计学意义（P〈0．05）；A组患者的NIHSS评分显著优于B组和C组评分，差异有统计学意义（P〈0．05）；ADL评分显著优于B组和C组评分，差异有统计学意义（P〈0．05）；A组术后并发症发生率为3．33％（1／30），显著低于B组的30．0％（9／30）和C组的36．67％（11／30），差异有统计学意义（P〈0．05）。【结论】超早期微创穿刺引流手术对于基底节区脑出血患者具有明显疗效，恢复迅速，不良反应少，值得于临床广泛推广使用。

[Objective]To compare the clinical efficacy of ultra-early minimally invasive puncture drainage, posterior frontal approach for aspiration and drainage of basal ganglian hematomas and small bone window CT guided drilling drainage on patients with hypertensive cerebral hemorrhage in basal ganglia.[Methods]Ninety cases of hypertensive cerebral hemorrhage in our hospital from January 2015 to January 2016 were chosen, all objects were divided into three groups according to the random grouping principle., the group of ultra-early minimally invasive puncture drainage（Group A）, the group of posterior frontal approach for aspiration and drainage of basal ganglian hematomas （Group B） and the group of small bone window CT guided drilling drainage （Group C）, 30 cases for each. Postoperative hematoma absorption, neurological impairment score （NIHSS score）, ability of daily life score （ADL score） and postoperative complications of the three groups of patients were analyzed and compared.[Results]The hematoma size of the Group A was significantly smaller than that of the Group B and the Group C, the difference was statistically significant （ P 〈0.05） ; The total absorption time of hematoma in the Group A was significantly shorter than that in the Group B and the Group C, the difference was statistically significant （ P 〈0.05） ; The NIHSS score of the Group A was significantly better than that of the Group B and the Group C, and the difference was statistically significant （ P 〈0.05）, and the ADL score was significantly better than that of the Group B and the Group C, the difference was statistically significant （ P 〈0.05） ; The incidence of postoperative complications in the Group A was 3.33 % （1/ 30）, which was significantly lower than that in the Group B 30.0% （9/30） and the Group C 36.67% （11/30）, the difference was statistically significant （ P 〈0.05）.[Conclusion]Ultra early minimally invasive surgery for cerebral hemorrhage in basal ganglia has obvious curative effect, rapid recovery and less adverse reactions, it is worth to be widely used in clinical practice.