小骨窗微创手术治疗急性基底节区高血压脑出血疗效分析

Small bone-window of minimally invasive surgery on acute basal ganglia hypertensive intracerebral hemorrhage

目的探讨小骨窗微创手术治疗急性基底节区高血压脑出血的临床疗效及安全性。方法选取自2015年1月至2016年5月空军军医大学唐都医院收治的急性基底节区高血压脑出血患者164例为研究对象,根据手术方式不同分为传统组(n=86)和微创组(n=78)。比较两种手术方式对急性基底节区高血压脑出血患者的恢复情况、并发症以及预后情况的影响。结果微创组手术时间明显短于传统组(P<0.05),术中失血量明显低于传统组(P<0.05),拔管时间和住院时间均明显短于传统组(P<0.05),两组血肿清除效果相当,且在再出血和住院病死率方面比较,差异均无统计学差异(P>0.05)。术后2周,两组昏迷程度及神经功能均较术前明显改善,但差异无统计学意义(P>0.05);两组血清炎症水平均较术前明显下降,且微创组炎症水平明显低于传统组(P<0.05)。在并发症上,微创组肺部感染比例和并发症总发生率均明显低于传统组(P<0.05)。术后半年,微创组日常生活能力量表预后评级Ⅰ~Ⅲ级的患者比例略高于传统组,差异无统计学意义(P>0.05)。结论小骨窗微创手术具有和传统手术相当的血肿清除效果,但小骨窗微创手术对患者创伤小,患者恢复较快,并发症较少。

Objective To investigate the curative effect and security of small bone-window minimally invasive surgery on acute basal ganglia hypertensive intracerebral hemorrhage. Methods A retrospective study was performed on 164 cases of patients with acute basal ganglia hypertensive intracerebral hemorrhage who were admitted from January 2015 to May 2016. According to different surgical methods,patients were divided into the conventional group（ n = 86） and the minimally invasive group（ n = 78）. The recovery status,complications and prognosis of patients with acute hypertensive intracerebral hemorrhage in the basal ganglia region were compared between the two groups. Results The operation time of the minimally invasive group was significantly shorter than that of the conventional group（ P〈0. 05）,intraoperative blood loss was significantly less than that in the conventional group（ P〈0. 05）,extubation time and length of stay were significantly shorter than those in the conventional group（ P〈0. 05）,the effects on hematoma clearance were the same,there was no statistically significant difference in re-bleeding or in-hospital mortality（ P〉0. 05）. Two weeks after operation,the coma degree and neurological function of the two groups were significantly improved,while there was no statistically significant difference between the two groups（ P〉0. 05）; the levels of inflammation in both groups were significantly lower than those before the surgery,and the level of inflammation in the minimally invasive group was significantly lower than that in the conventional group（ P〈0. 05）. The complications such as the proportion of pulmonary infection and the total incidence of complications in the minimally invasive group were significantly lower than those in the conventional group（ P〈0. 05）. Six months after the surgery,the proportion of activities of daily living prognosis rating I-III grade in the minimally invasive group was slightly higher than that in the conventional group,while the difference was not statistically significant（ P〉0. 05）. Conclusion Small bone-window of minimally invasive surgery has the same effect as the conventional surgery,and with the advantages of small trauma,faster recovery and less complications.