CT定位辅助下微创穿刺引流术与小骨窗开颅血肿清除术治疗高血压脑出血的效果比较

Comparison of the efficacy of microtraumatic craniopuncture assisted by CT versus small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage

目的探究CT定位辅助下微创穿刺引流术与小骨窗开颅血肿清除术治疗高血压脑出血(HICH)的效果。方法抽取2017年8月至2019年10月济源市中医院收治的HICH患者165例,采用随机数字表法分为A组(85例)和B组(80例)。A组患者接受微创穿刺引流术,B组患者接受小骨窗开颅血肿清除术,观察比较两组手术时间、术中失血量、血肿清除率、住院时间、神经功能缺损评分(NFDS)、改良Bathel指数(MBI)、再出血率、病死率及并发症发生情况。结果A组手术时间、住院时间、术中出血量[(1.65±0.63)h、(8.45±1.85)d、(44.34±4.71)ml]少于B组[(2.87±0.54)min、(13.06±2.07)d、(242.16±56.89)ml],血肿清除率[(89.37±4.95)%]大于B组[(72.68±6.13)%],P<0.05。治疗前,两组NFDS评分和MBI评分比较差异未见统计学意义(P>0.05);治疗后,两组NFDS评分较治疗前下降,MBI评分较治疗前增大(P<0.05),且A组NFDS评分低于B组,MBI评分高于B组(P<0.05)。两组再出血率和病死率比较差异未见统计学意义(P>0.05);A组总并发症发生率(3.35%,3/85)低于B组(12.50%,10/80),P<0.05。结论CT定位辅助下微创穿刺引流术对HICH的治疗效果优于小骨窗开颅血肿清除术,能有效清除血肿,促进神经功能及生活能力恢复,改善预后情况。

Objective To compare the efficacy of microtraumatic craniopuncture assisted by computed tomography (CT) versus small bone window craniotomy for hematoma removal in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods A total of 165 HICH patients in Jiyuan Traditional Chinese Medicine Hospital from August 2017 to October 2019 were enrolled, and divided into group A (n=85) and group B (n=80) by random number table method. Patients in group A were treated by microtraumatic craniopuncture, while patients in group B were treated by small bone window craniotomy. The operative time, intraoperative blood loss, hematoma removal rate, hospital stay, neurological functional deficit scale score (NFDS), modified Bathel index (MBI), rate of rebleeding, case fatality rate and complications were observed and compared between the two groups.Results The operative time, hospital stay and intraoperative blood loss in group A were (1.65±0.63)h, (8.45±1.85)d, (44.34±4.71)ml, respectively, which were significantly less than the (2.87±0.54)min, (13.06±2.07)d, (242.16±56.89)ml in group B, and the hematoma clearance rate in group A was (89.37±4.95)%, which was significantly higher than the (72.68±6.13)% in group B (P<0.05). NFDS and MBI scores had no difference between the two groups before treatment (P>0.05). After treatment, NFDS score decreased in both groups (P<0.05), and it was lower in group A than in group B (P<0.05);meanwhile, MBI score increased in both groups (P<0.05), and it was higher in group A than in group B (P<0.05). The rebleeding rate and case fatality rate had no significant difference between the two groups (P>0.05). The overall complication rate of group A (3.35%, 3/85) was lower than that of group B (12.50%, 10/80), P<0.05.Conclusions Compared with small bone window craniotomy, application of microtraumatic craniopuncture assisted by CT has better curative effects for HICH patients, which can effectively remove the hematoma, promote the recovery of nerve function and living ability and improve the prognosis.