两种术式对基底节脑出血患者神经功能及预后恢复的影响

Comparison on Effects of the Two Surgical Methods on Nerve Function and Prognosis Recovery of Patients with Cerebral Hemorrhage in Basal Ganglia

目的观察大骨瓣开颅血肿清除术及小骨窗经外侧裂显微镜下清除术对高血压基底节脑出血患者神经功能及预后恢复的影响。方法选取2015年6月-2018年6月安阳地区医院神经外科行手术治疗基底节脑出血患者120例,据手术方式分为开颅组(大骨瓣开颅血肿清除术)及显微组(小骨窗经外侧裂显微镜下清除术),各60例。记录患者手术时间及术中出血量,观察患者神经功能及意识状态变化,比较两组血肿清除率及预后情况。结果显微组手术时间短于开颅组,术中出血量少于开颅组(P<0.05)。两组术后3dGCS评分较术前提高,NIHSS评分较术前降低(P<0.05);但两组GCS、NIHSS评分改善情况无明显差异(P>0.05)。两组血肿清除率无明显差异(P>0.05)。轻、中型患者两组术后6月BI评分无明显差异(P>0.05);重型患者开颅组BI评分高于显微组(P<0.05)。结论两种术式对于治疗基底节脑出血患者各有优劣,但小骨窗经外侧裂显微镜下清除术更有优势。

Objective To observe the effects of large craniotomy for hematoma elimination and transsylvian approach small bone microscopic window hematoma elimination on nerve function and prognosis recovery of patients with hypertensive cerebral hemorrhage in basal ganglia. Methods 120 patients with cerebral hemorrhage in basal ganglia who underwent surgery in the Second Department of Neurology of Hospital in Anyang District,from June 2015 to June 2018 were enrolled.They were divided into craniotomy group (large craniotomy for hematoma elimination) and microscope group (transsylvian approach small bone microscopic window hematoma elimination),60 cases in each group.The operation time and intraoperative blood loss were recorded.The changes in nerve function and consciousness status were observed.The hematoma clearance rate and prognosis were compared between the two groups. Results The operation time of microscope group was shorter than that of craniotomy group,and intraoperative blood loss was less than that of craniotomy group ( P <0.05).The GCS scores of the two groups were higher than those before surgery,and the NIHSS scores were lower than those before surgery ( P <0.05).However,there was no significant difference in improvement of GCS and NIHSS scores between the two groups ( P >0.05).There was no significant difference in hematoma clearance rate between the two groups ( P >0.05).There was no significant difference in BI score between the two groups ( P >0.05).The scores of severe patients in craniotomy group were higher than those in microscope group ( P <0.05). Conclusion There are respective advantages of both surgical methods in treatment of patients with cerebral hemorrhage in basal ganglia.However,the transsylvian approach small bone microscopic window hematoma elimination is more advantageous.