显微镜下经侧裂入路开颅血肿清除术对基底节区高血压脑出血患者术后NIHSS评分及生存质量的影响

Effect of microscopic craniotomy via lateral fissure approach on NIHSS score and quality of life in patients with hypertensive intracerebral hemorrhage in basal ganglia

目的探讨显微镜下经侧裂入路开颅血肿清除术对基底节区高血压脑出血患者术后美国国立卫生研究院卒中量表评分及生存质量的影响.方法将80例基底节区高血压脑出血患者按简单随机化分组法分为两组,每组40例.对照组实施显微镜下经颞中回入路开颅血肿清除术,观察组实施显微镜下经测裂入路开颅血肿清除术,比较两组手术情况、住院时间、血肿清除率、美国国立卫生研究院卒中量表评分、格拉斯哥昏迷评分、格拉斯哥预后量表评分、生活质量评分.结果观察组术中出血量显著少于对照组,引流时间、住院时间显著短于对照组,血肿清除率显著高于对照组,差异均有统计学意义(P<0.01);观察组术后3d、7d、14 d美国国立卫生研究院卒中量表评分显著低于对照组(P<0.05或0.01),格拉斯哥昏迷评分显著高于对照组(P<0.01);术后1个月观察组格拉斯哥预后量表、生活质量评分显著高于对照组(P<0.01),并发症发生率(2.5%)与对照组(5.0%)比较差异无统计学意义(P>0.05).结论显微镜下经侧裂入路开颅血肿清除术应用于基底节区高血压脑出血患者,可减少术中出血量,缩短引流时间、住院时间,提高血肿清除率,促进患者神经功能、意识状态早期恢复,提高患者生存质量.

Objective To analyze the effect of microscopic craniotomy via lateral fissure approach on NIHSS score and quality of life in patients with hypertensive intracerebral hemorrhage in basal ganglia.Methods 80 patients with HICHwere selected and randomly divided into two groups,40 cases in each group.The control group underwent craniotomy via middle temporal gyrus under microscope,while the observation group underwent craniotomy via lateral fissure under microscope.The operation conditions,hospital stay,hematoma clearance rate,NIHSS score,Glasgow coma score(GCS),Glasgow prognostic scale score(GOS)and quality of life score(QOL)were compared between the two groups.Results The bleeding volume,drainage time and hospitalization time of the observation group were lower than that of the control group,and the clearance rate of hematoma was higher than that of the control group(P<0.01).The NIHSS score of the observation group was lower than that of the control group on the 3rd,7th and 14th day after operation(P<0.05 or 0.01),the GCS score of the observation group was higher than that of the control group(P<0.01).The GOS and QOL scores in the observation group were significantly higher than those in the control group at one month after operation(P<0.01).There was no significant difference in the incidence of complications(2.5%)compared with the control group(5.0%)(P>0.05).Conclusions Microscopic craniotomy via lateral fiss ure approach for HICH patients in basal ganglia can reduce intraoperative bleeding,shorten drainage time and hospitalization time,improve hematoma clearance rate,promote early recovery of neurological function and consciousness,and improve the quality of life of patients.