脑立体定向超早期微创冲水法手术治疗幕上高血压脑出血的效果及对患者预后的影响

Effectiveness of Cerebral Stereotactic Ultra-early Minimally Invasive Water Jetting Operation in Treatment of Patients with Supratentorial Hypertensive Cerebral Hemorrhage and Its Effects on Prognosis

目的探讨脑立体定向超早期微创冲水法手术治疗幕上高血压脑出血的效果和对患者预后的影响。方法回顾性分析2016年1月——2018年9月收治的82例幕上高血压脑出血患者的临床资料。根据治疗方式的不同分为观察组42例和对照组40例,观察组行脑立体定向超早期微创冲水法手术治疗,对照组行常规开颅手术治疗。比较2组手术指标、血肿清除率、术后并发症发生率,观察术前和术后1周患者的格拉斯哥昏迷量表(GCS)评分变化情况,记录术后6个月患者的日常生活活动能力(ADL)分级和格拉斯哥预后量表(GOS)评分情况。结果观察组手术时间和住院时间均短于对照组,术中出血量少于对照组,血肿清除率高于对照组,术后并发症发生率低于对照组(P<0.01);2组术后1周的GCS评分均较术前升高,且观察组高于对照组(P<0.01);术后6个月,观察组术后恢复优良患者比例和预后良好率均高于对照组(P<0.01)。结论脑立体定向超早期微创冲水法手术治疗幕上高血压脑出血的效果显著,出血创伤小,并发症少,安全性高,能显著改善患者预后。

Objective To investigate effectiveness of cerebral stereotactic ultra-early minimally invasive water jetting operation in treatment of patients with supratentorial hypertensive cerebral hemorrhage and its effects on the prognosis.Methods Clinical data of 82 patients with supratentorial hypertensive cerebral hemorrhage admitted during January 2016 and September 2018 was retrospectively analyzed,and the patients were divided into observation group(n=42)and control group(n=40)according to different therapeutic methods.Observation group was treated with stereotactic ultra-early minimally invasive water jetting operation,while control group was treated with routine craniotomy.In two groups,operative indexes,hematoma clearance rate and incidence rate of postoperative complications were compared;changes of Glasgow Coma Score(GCS)before and in 1 week after operation were observed,and ability of daily living(ADL)grading and Glasgow Outcome Score(GOS)were recorded in 6 months after operation.Results In observation group,values of operative time,hospital stay,intraoperative volume of blood loss and incidence rate of postoperative complications were significantly lower,while hematoma clearance rate was significantly higher than those in control group(P<0.01).GCS scores in 1 week after operation were significantly higher than those before operation in two groups,and the score in observation group was significantly higher than that in control group(P<0.01).In 6 months after operation,proportion of patients with postoperative good recovery and good prognosis rate in observation group were significantly higher than those in control group(P<0.01).Conclusion Cerebral stereotactic ultra-early minimally invasive water jetting operation in treatment of patients with supratentorial hypertensive cerebral hemorrhage may achieve good effectiveness with less bleeding and trauma,few complications and good safety,and it may significantly improve prognosis of patients.