神经内镜下与开颅血肿清除术对老年高血压性脑出血疗效的对比研究

Effect of neuroendoscopic and craniotomic removal of hematoma on hypertensive intracerebral hemorrhage in the elderly

目的探讨神经内镜下与开颅血肿清除术治疗老年高血压性脑出血的疗效.方法选取我院收治的老年高血压性脑出血患者120例,根据随机数表法分为神经内镜组和开颅组,每组60例.开颅组采用传统开颅血肿清除术治疗,神经内镜组采用神经内镜下脑内血肿清除术,观察2组患者临床疗效,并对2组血清内皮素、C反应蛋白(CRP)及白细胞介素6(IL-6)水平、手术相关指标、预后程度、并发症发生率进行比较.结果治疗后,神经内镜组总有效率明显高于开颅组,差异有统计学意义(93.3% vs 78.3%,P<0.05).与治疗前比较,治疗后2组血清内皮素、CRP、IL-6水平明显降低(P<0.05),且神经内镜组血清内皮素、CRP、IL-6水平明显低于开颅组,差异有统计学意义[(68.39±8.29)ng/L vs (84.52±10.96)ng/L,(15.03±2.19)mg/Lvs (21.61±3.61)mg/L,(23.61±3.61)μg/L vs (41.19±5.06)μg/L,P<0.01];与开颅组比较,神经内镜组术中出血量明显减少、血肿清除率明显升高、预后更优,术后并发症发生率更低,差异有统计学意义(P<0.05,P<0.01).结论与传统开颅血肿清除术相比,神经内镜下脑内血肿清除术疗效更加显著,可明显改善患者预后,且术后并发症较少.

Objective To study the effect of neuroendoscopic and craniotomic removal of hematoma on hypertensive intracerebral hemorrhage in the elderly.Methods One hundred and twenty hypertensive intracerebral hemorrhage patients admitted to our hospital were divided into neuroendoscopy group and craniotomy group(n=60).The patients in craniotomy group received traditional craniotomic removal of hematoma and those in neuroendoscopy group underwent neuroendoscopic removal of hematoma.The effects of surgical procedures on hypertensive intracerebral hemorrhage were compared in two groups.The serum ET,CRP,IL-6 levels in 2 groups were measured.The operation-related parameters,outcome and complications were compared between the two groups.Results The efficiency of neuroendoscopic and craniotomic removal of hematoma on hypertensive intracerebral hemorrhage was significantly higher in neuroendoscopy group than in craniotomy group(P <0.05).The serum ET,CRP and IL-6 levels were significantly lower in two groups(P <0.05)and in neuroendoscopy group than in craniotomy group after operation (P <0.05).The bleeding volume was significantly smaller while the hematoma removal rate was significantly higher and the incidence of complications was significantly lower in neuroendoscopy group than in craniotomy group(P <0.05,P <0.01).Conclusion The effect of neuroendoscopic removal of hematoma is better than that of traditional craniotomic removal of hematoma on hypertensive intracerebral hemorrhage in the elderly,which indicates that neuroendoscopic removal of hematoma can improve the outcome and reduce the postoperative comlications.