幕上中等量高血压脑出血不同手术方式的临床疗效比较

Clinical effect of different surgeries for the treatment of moderate supratentorial hypertensive intracerebral hemorrhage:A comparative study

目的比较传统骨瓣开颅术、小骨窗开颅术、微创钻孔外引流术治疗幕上中等量高血压脑出血患者的疗效。方法收集93例高血压脑出血患者的临床资料,将其按手术方式不同分为传统骨瓣开颅组(A组,33例),小骨窗开颅组(B组,29例)和微创钻孔外引流组(C组,31例)。记录并比较三组患者的基线情况、手术情况及预后情况指标。结果三组患者性别、年龄、入院时收缩压、术前GCS评分、术前血肿体积、术后第三、第七天GCS评分、再出血、颅内感染、死亡率和术后6个月mRS指标差异无统计学意义(P>0.05);A组与B组血肿清除率优于C组(P<0.001);C组手术时间最短、术中出血量最少(P<0.001),术后第一天GCS评分、入住ICU时间和住院时间、肺部感染均优于A组(P<0.05)。结论对于幕上中等出血量的高血压脑出血患者,微创钻孔外引流术安全有效,值得临床推广。

Objective To compare the clinical effect of traditional craniotomy,small bone flap craniotomy,and minimally invasive drilling and drainage in the treatment of moderate supratentorial hypertensive intracerebral hemorrhage.Methods Clinical data were collected from 93 patients with hypertensive intracerebral hemorrhage,and according to the surgical procedure,they were divided into traditional craniotomy group(group A with 33 patients),small bone flap craniotomy group(group B with 29 patients),and minimally invasive drilling and drainage group(group C with 31 patients).The three groups were compared in terms of baseline conditions,surgical conditions,and prognosis.Results There were no significant differences between the three groups in sex,age,systolic pressure on admission,preoperative GCS score,preoperative hematoma volume,GCS score on days 3 and 7 after surgery,rebleeding,intracranial infection,mortality rate,and mRS index at 6 months after surgery(P>0.05).Groups A and B had had a significantly better hematoma clearance rate than group C(P<0.001).Group C had the shortest time of operation and least intraoperative blood loss(P<0.001),and compared with group A,group C had significantly better GCS score on day 1 after surgery,duration of ICU stay,length of hospital stay,and pulmonary infection(P<0.05).Conclusions Minimally invasive drilling and drainage is safe and effective for patients with moderate supratentorial hypertensive intracerebral hemorrhage and thus holds promise for clinical application.