超早期小骨窗开颅血肿清除术治疗老年高血压脑出血的临床效果

Clinical effect of super early small bone window craniotomy for hematoma removal in the treatment of senile hypertensive intracerebral hemorrhage

目的探讨超早期小骨窗开颅血肿清除术治疗老年高血压脑出血(HICH)的临床效果。方法回顾性分析2018年1月至2019年3月在我院接受小骨窗开颅血肿清除术治疗的86例老年HICH患者的病例资料,按照患者出血至手术间隔时间分为观察组(≤出血后6 h)与对照组(出血后7~24 h),每组43例。比较两组的治疗效果。结果观察组达到血肿完全清除患者占比高于对照组(P<0.05)。两组术后再出血率比较,差异无统计学意义(P>0.05)。术后,两组患者的NSE、NPY、D-D水平均显著降低,且观察组低于对照组(P<0.05)。手术后6个月,观察组GOS评分高于对照组,且NIHSS评分低于对照组(P<0.05)。手术后6个月,两组SIS及Barthel指数评分均显著高于术前,且观察组高于对照组(P<0.05)。结论超早期小骨窗开颅血肿清除术治疗老年HICH有良好的效果,不仅可提高血肿清除率,保护脑神经,改善患者的神经功能和生活质量,而且不增加再出血风险。

Objective To explore the clinical effect of super early small bone window craniotomy for hematoma removal in the treatment of senile hypertensive intracerebral hemorrhage(HICH).Methods The data of 86 elderly patients with HICH who received small bone window craniotomy for hematoma removal in our hospital from January 2018 to March 2019 were analyzed retrospectively.According to the time interval between bleeding and operation,the patients were divided into observation group(less than 6 hours after bleeding)and control group(7-24 hours after bleeding),with 43 cases in each group.The therapeutic effects of the two groups were compared.Results The proportion of patients who got complete clearance of hematoma in the observation group was higher than that in the control group(P<0.05).There was no significant difference in postoperative rebleeding rate between the two groups(P>0.05).After operation,the levels of NSE,NPY and D-D in the two groups decreased significantly,and those of the observation group were lower than the control group(P<0.05).Six months after operation,the GOS scores in the observation group was higher than that in the control group,the NIHSS score was lower than that in the control group(P<0.05).Six months after operation,SIS and Barthel index scores of the two groups were significantly higher than those before operation,and those of the observation group were higher than the control group(P<0.05).Conclusion Super early small bone window craniotomy for hematoma removal has a good effect on senile HICH.It can not only improve the clearance rate of hematoma,protect the brain nerves,improve the nerve function and quality of life of patients,but also don’t increase the risk of rebleeding.