小骨窗开颅术、骨瓣开颅术和钻孔引流术治疗高血压脑出血临床疗效及安全性对比分析

A Comparative Study of Therapeutic Effects and Safety Among Small Bone Flap Craniotomy, Traditional Craniotomy, Repanation and Drainage in Patients with Hypertensive Cerebral Hemorrhage

【目的】比较小骨窗开颅术、骨瓣开颅术和钻孔引流术治疗高血压脑出血临床疗效及安全性。【方法】回顾性分析2012年6月至2017年8月本院收治的150例高血压脑出血患者的临床资料,并根据治疗方式的不同分为A组（小骨窗开颅术治疗,n=63）,B组（骨瓣开颅术治疗,n=30）,C组（钻孔引流术治疗,n=57）,比较并分析三组患者治疗疗效、手术时间、术中出血量、住院时间,术后并发症发生情况及术前、术后3个月神经功能缺损（GSS）、日常生活能力评分（ADL）评分和预后情况等。【结果】A、C组手术时间、术中出血量、住院时间均低于B组,C组手术时间低于A组,组间比较差异具有统计学意义（P〈0.05）。三组患者术前GSS、ADL评分比较差异无统计学意义（P〉0.05）;术后3个月三组患者GSS评分均低于术前,ADL评分均高于术前,A组GSS评分显著高于B、C组,ADL评分低于B、C组,差异具有统计学意义（P〈0.05）。B组术后并发症总发生率明显高于A组、C组,差异具具有统计学意义（P〈0.05）。B组预后良好率明显低于A组、C组,差异具有统计意义（P〈0.05）;B、C组治疗总有效率略高于A组,但组间比较差异无统计学意义（P〉0.05）。A、B、C组术后三个月病死率比较差异无统计学意义（χ2=0.261,P=0.878〉0.05）。【结论】小骨窗开颅术、骨瓣开颅术和钻孔引流术治疗高血压脑出血患者有各自优缺点,临床应结合患者各方面情况选择最为合适的术式。

【Objective】To compare and analyze the therapeutic effects and safety of small bone flap craniotomy, traditional craniotomy, repanation and drainage in patients with hypertensive cerebral hemorrhage.【Methods】The clinical data of 150 patients with hypertensive intracerebral hemorrhage treated in our hospital from June 2012 to August 2017 were retrospectively analyzed and patients were divided into group A （63 cases）, group B （30 cases）, group C （57 cases）, according to the different treatment methods. Patients in the group A were treated with small bone flap craniotomy, patients in the group B were treated with traditional craniotomy, and patients in the group C were treated with trepanation and drainage. Then the curative effect, operative time, intraoperative blood loss, hospitalization time, postoperative complications, GSS, ADL score and prognosis of the three groups were compared and analyzed.【Results】The operation time, intraoperative blood loss and hospital stay in the group B were higher than those in the groups A and C （P〈0.05）; The operation time in the group A was longer than that in the group C （P〈0.05）, but the intraoperative blood loss and the hospitalization time of the group A and the group C had no significant difference （P〉0.05）. GSS scores of the three groups at 3 months post-operation decreased, while ADL scores increased （P〈0.05）; The GSS scores in the group A were higher than those in the group B and C at 3 months after operation, and the ADL scores in the group A were lower than those in the group B and C （P〈0.05）, moreover no significant difference was found in the GSS and ADL scores between the group B and the group C at 3 months post-operation （P〉0.05）; The total incidence of postoperative complications in the group B was significantly higher than that in the group A and the group C （P〈0.05）, while no significant difference was found in the incidence of postoperative complications between the group A and the group C （P〉0.05）; The good prognosis rate of the group B was significantly lower than that of the group A and C （P〈0.05）, with no significant difference between the group A and the group C （P〉0.05）; The total effective treatment of the group B and C was slightly higher than that of the group A, but there was no statistical difference between the three groups （P〉0.05）.【Conclusion】The comparison among small bone flap craniotomy, traditional craniotomy, repanation and drainage shows that each treatment has its own advantages and disadvantages, the application should combined with patient＇s condition.