微创与去骨瓣血肿清除术治疗不同血肿量高血压性基底节出血的临床对比研究

Clinical control study of minimally invasive and decompressive craniectomy hematoma removal in treating hypertensive basal ganglia hemorrhage with different hematoma quantity

目的探讨微创与去骨瓣血肿清除术治疗不同血肿量高血压性基底节出血(HBGH)的临床疗效。方法回顾性分析武警后勤学院附属医院脑科医院自2014年11月至2016年11月282例HBGH患者的临床资料。患者行CT检查,并通过多田公式计算血肿量。将患者按照治疗方法不同分为微创血肿手术组和去骨瓣血肿清除术组。比较2组手术15 d后患者的意识状态(GCS评分)、神经功能缺损情况[美国国立卫生研究院卒中量表(NIHSS)评分]、患者住院时间、手术后并发症及死亡率情况。结果 (1)对于血肿量为30～49 ml、50～69 ml的患者,微创与去骨瓣2组间手术后15 d GCS评分无明显差异,而对于血肿量为70～100 ml的患者,去骨瓣组手术后15 d GCS评分优于微创组,差异具有统计学意义(t=2.582,P<0.05);(2)对于血肿量为30～49 ml的患者,微创组手术后15 d NIHSS评分优于去骨瓣组,差异具有统计学意义(t=2.818,P<0.05),而对于血肿量为50～69 ml、70～100 ml的患者,组间差异无统计学意义(P>0.05);(3)对于血肿量为30～49 ml的患者,微创组患者住院时间短于去骨瓣组,差异具有统计学意义(t=2.994,P<0.05),而对于血肿量为50～69 ml、70～100 ml的患者,组间差异无统计学意义(P>0.05);(4)对于血肿量为30～49 ml、50～69 ml、70～100 ml的患者,微创与去骨瓣2组间并发症及死亡率差异均无统计学意义(P>0.05)。结论治疗HBGH,血肿量较小患者采用微创手术进行治疗临床效果较佳;中等出血量患者采用微创与去骨瓣手术方式,临床效果无明显差异;血肿量较大者使用去骨瓣手术对促进神经功能的恢复以及提高患者术后生活质量效果较微创更好。

Objective To investigate the clinic effect of minimally invasive and decompressive craniectomy hematoma removal in treating hypertensive basal ganglia hemorrhage（HBGH） with different hematoma quantity. Methods Two hundred and eighty-two cases with HBGH in Affiliated Hospital of Logistics College of Chinese People ＇s Armed Police Force from November 2014 to November 2016 were selected and given CT examination. Then they were divided into minimally invasive hematoma group and decompressive craniectomy hematoma removal group. Record and compare the GCS, National Institute of Health stroke scale（NIHSS） of the two groups after 15 d post-treatment, as well as, hospital stay time,complications and death rate. Results（1） As for patients with hematoma volume of 30-49 ml and 50-69 ml, GCS had no obvious difference between two groups after 15 d post-surgery. However, for patients with hematoma volume of 70-100 ml, the scores of GCS in decompressive craniectomy hematoma removal group were better than that of minimally invasive hematoma group（t=2.582, P0.05）.（2） As for patients with hematoma volume of 30-49 ml, the scores of NIHSS in minimally invasive hematoma group were better than that of decompressive craniectomy hematoma removal group after 15 d post-surgery（t=2.818,P0.05）. However, for patients with hematoma volume of 50-69 ml and 70-100 ml, there were no obvious difference of NIHSS between two groups.（3） As for patients with hematoma volume of 30-49 ml, the hospital stay time in minimally invasive hematoma group was shorter than of decompressive craniectomy hematoma removal group（t =2.994, P〈0.05）. However, for patients with hematoma volume of 50-69 ml and 70-100 ml, the hospital stay time had no statistic significance between two groups.（4） Complication occurrence rate and death rate of patients with different hematoma volume had no statistic significance.Conclusion In treatment of HBGH, small hematoma volume should be given minimally invasive surgery, medium hematoma volume should be given minimally invasive or decompressive craniectomy,and patients with large hematoma volume given decompressive craniectomy hematoma removal could recover neurological function and improve life quality.