神经内镜与开颅血肿清除术治疗高血压脑出血的效果对比

A comparison of efficacy of endoscopic management vs.craniotomic hematoma evacuation on hypertensive intracerebral hemorrhage

目的对比分析神经内镜与开颅血肿清除术对高血压脑出血(HICH)的治疗效果。方法回顾性分析58例经神经内镜治疗(实验组)和68例经开颅血肿清除术治疗(对照组)的HICH患者,观察2组手术时间、术中失血量、血肿清除率和格拉斯哥预后评分,采用Logistic回归分析预后的影响因素。结果实验组手术时间显著短于对照组(t=-15.126,P<0.001),术中失血量显著少于对照组(t=-9.591,P<0.001),血肿清除率显著高于对照组(t=2.289,P=0.024),2组GOS评分比较差异有统计学意义(χ2=10.843,P=0.028),是否破入脑室为影响预后的因素(P=0.045,OR=0.646,95%CI 0.447~1.245)。结论神经内镜在HICH中的治疗效果优于开颅血肿清除术,虽受到是否破入脑室的影响,但值得临床推广应用。

Objective To compare the efficacy of endoscopic management vs. craniotomic hematoma evacuation on hypertensive intracerebral hemorrhage（HfCH）. Methods A retrospective analysis of 126 patients with HICH,in which,58 were treated with endoscopic management（experimental group, EG）, and 68 were craniotomic hematoma evacuation（control group, CG）, Chi- Square and t tests were used to compare the operative time,intraoperative blood loss,hematoma clearance and Glasgow outcome scale（GOS） between the two groups,then Logistic analysis was used to detect the affecting factors of the prognosis. Results Operative time was significantly shorter（t =- 15. 126 ,P〈0. 001）, intraoperative blood loss was significantly less（t =- 9. 591, P〈0. 001） ,and hematoma was significantly higher（t = 2. 289,P = 0. 024）in EG than that in CG;the distribution of GOS between the two groups was significant difference（x2 ： 10. 843,P = 0. 028） ;whether or not broken into ventricles was a prognostic factor（P= 0. 045,OR =0. 646,95% CI 0. 447-1. 245）. Conclusion Neuroendoscope is more efficacy than craniotomy in HICH,although affected by breaking into the ventricle, it is worthy for clinical application.