神经内镜与微创穿刺治高血压脑出血疗效比较

Comparison of the Curative Effects of Endoscopic Surgery and Minimally Invasive Puncture in Patients with Hypertensive Intracerebral Hemorrhage

目的比较神经内镜与微创穿刺治疗高血压脑出血的效果。方法收集96例高血压脑出血患者,随机分为内镜组和微创穿刺组各48例,分别采取神经内镜和微创穿刺的方法进行手术治疗,记录手术时长和术中出血量。术后1、3、7 d复查头部CT计算残余血肿量、血肿清除率;术后7 d、1个月、3个月评估患者的神经功能缺损情况(NIHSS评分)和生活能力(BI评分)。同时记录术后1个月内再出血和颅内感染等并发症的发生情况。结果内镜组的手术时长较微创穿刺组显著增长(P=0.020),术中出血量未见显著差异。术后内镜组的残余血肿量明显低于微创穿刺组,血肿清除率高于微创穿刺组(P=0.000)。术后1个月、3个月,两组的NIHSS、BI分别呈现下降和上升的趋势,且内镜组优于微创穿刺组(P<0.05)。内镜组的术后再出血发生率显著低于微创穿刺组(P=0.026),内镜组的颅内感染为2.27%,微创穿刺组为11.36%,两组比较无统计学差异(P=0.204)。结论神经内镜对高血压脑出血的治疗效果优于微创穿刺手术,值得临床推广应用。

Objective To compare the curative effects of endoscopic surgery and minimally invasive puncture in patients with hypertensive intracerebral hemorrhage（HICH）. Methods Ninety-six patients with HICH were randomly divided into the endoscopic group and minimally invasive puncture group（48 for each）and received endoscopic surgery and minimally invasive puncture respectively. Results The operative duration of the endoscopic group were significantly longer than minimally invasive puncture group（P = 0. 020）,while no difference was found in intraoperative hemorrhage. The amount of residual hematoma in endoscopic group was significantly lower than that in the minimally invasive group,and the hematoma clearance rate was higher than that of the minimally invasive group（P = 0. 000）. NIHSS and BI scores of both groups respectively decreased and increased after operation. And NIHSS was higher and BI scores were lower in the minimally invasive puncture group 1 month and 3 months after operation. The postoperative intracerebral infection rate was2. 27 % in the endoscopic group,and 11. 36 % of the minimally invasive puncture group,with no significant difference（P = 0. 204）. Conclusion The curative effects of endoscopic surgery for HICH are better than minimally invasive puncture. It is worthy of promotion in clinic.