早期颅内血肿微创清除术对轻中度基底核区高血压脑出血患者神经功能及认知功能的影响

Effects of Minimal Invasive Surgery of Intracranial Hematoma in Early Stage on the Neurological and Cognitive Function in Patients with Mild to Moderate Hypertensive Basal Ganglia Hemorrhage

目的:探讨早期颅内血肿微创清除术对轻中度基底核区高血压脑出血(hypertensive intracerebral hemorrhage, HICH)患者神经功能及认知功能的影响。方法:选取2016年9月-2017年6月收治102例轻中度基底核区HICH,根据随机数字表法分为观察组( n =52)和对照组( n =50)。观察组早期(发病24 h内)行颅内血肿微创清除术,对照组则行内科保守治疗。观察两组治疗72 h后的血肿量、血肿清除率,记录血肿消失时间,评估治疗1个月后神经功能缺损情况及认知功能。结果:与对照组比较,观察组治疗72 h的血肿量减少、血肿清除率升高,血肿消失时间缩短,差异均有统计学意义( P <0.01)。与对照组比较,观察组治疗1个月后神经功能缺损程度及脑卒中神经功能缺损评分降低,注意、延迟记忆、定向力评分及蒙特利尔认知评估量表总评分均升高,差异有统计学意义( P <0.05)。结论:早期行颅内血肿微创清除术的轻中度基底核区HICH患者的神经功能恢复较好,认知功能水平较高,可作为临床手术治疗方式。

Objective To investigate the effect of minimally invasive removal of intracranial hematoma in early stage on neurological and cognitive functions in patients with mild to moderate hypertensive basal ganglia hemorrhage (HBGH). Methods A total of 102 patients with mild to moderate HBGH who were treated from September 2016 to June 2017 were enrolled in this study. They were divided into observation group ( n =52) and control group ( n =50) according to random number table method. The observation group received minimally invasive removal of intracranial hematoma in the early stage (within 24 h of onset), while the control group received conservative medical treatment. The amount of hematoma and the clearance rate of hematoma were observed 72 h after treatment in both groups, the disappearance time of hematoma was recorded, and the neurological deficit and cognitive function were evaluated 1 month after treatment. Results Compared with the control group, the amount of hematoma was decreased, the clearance rate of hematoma was increased and the disappearance time of hematoma was shortened in the observation group 72 h after treatment ( P <0.01). Compared with the control group, the degree of neurological deficit and the score of neurological deficit in stroke in the observation group were decreased one month after treatment, while the scores of attention, delayed memory, and orientation as well as the total score of Montreal Cognitive Assessment Scale were increased, suggesting significant differences ( P <0.05). Conclusion Patients with mild to moderate HBGH undergoing minimally invasive surgery had better neurological function recovery and higher cognitive function, which can be the preferable surgical treatment for such patients.