微创钻孔引流术治疗基底节区高血压脑出血的效果观察

Observation on the effect of minimally invasive drilling and drainage in the treatment of hypertensive intracerebral hemorrhage in the basal ganglia

目的探讨基底节区高血压脑出血行微创钻孔引流术治疗效果。方法选取2017年3月—2019年3月我院基底节区高血压脑出血患者95例,依据治疗术式不同分为微创组(n=48)、传统组(n=47),微创组采取微创钻孔引流术,传统组施行传统开窗血肿清除术。对比2组手术情况、并发症发生情况、术前、术后1 d、3 d血肿量、血清谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平,术后进行6个月随访,统计2组预后情况与术前、术后6个月日常生活能力评分(BI)、生活质量评分(QLQ-C30)、神经功能评分(NIHSS)。结果微创组手术时间、住院时间、术后下床活动时间较传统组短,术中出血量较传统组低(P<0.05);2组并发症发生率相比,无明显差异(P>0.05);微创组术后1 d、3 d血肿量较传统组低(P<0.05);2组术后1 d、3 d血清GSH-Px、SOD水平较术前降低,但微创组高于传统组,血清MDA水平较术前提高,但微创组低于传统组(P<0.05);经术后6个月随访,无脱落病例,2组术后6个月BI、QLQ-C30较术前提高,且微创组高于传统组,NIHSS评分较术前降低,且微创组低于传统组(P<0.05);微创组预后情况优于传统组(P<0.05)。结论基底节区高血压脑出血患者行微创钻孔引流术治疗,术中出血量较少,手术时间较短,且可降低血清GSH-Px、MDA、SOD表达,恢复神经功能,有助于提高日常生活能力及生活质量,改善患者预后。

Objective To investigate the effect of minimally invasive drilling and drainage for hypertensive intracerebral hemorrhage in the basal ganglia.Methods 95 patients with hypertensive intracerebral hemorrhage in the basal ganglia of our hospital from March 2017 to March 2019 were selected.According to different treatment methods,they were divided into minimally invasive group(n=48)and traditional group(n=47).The minimally invasive group received minimally invasive drilling and drainage,and the traditional group received traditional fenestration hematoma removal.The operation status,complications,hematoma volume,serum glutathione peroxidase(GSH-Px),malondialdehyde(MDA),and superoxide dismutase(SOD)levels of the two groups were compared before and 1 d and 3 d after operation.After 6 months of follow-up,the prognosis and the barthel index score(BI),quality of life score(QLQ-C30)and neurological function score(NIHSS)before and 6 months after surgery of the 2 groups were counted.Results The operation time,hospital stay,and postoperative time to get out of bed in the minimally invasive group were shorter than those in the traditional group,and intraoperative blood loss was lower than that in the traditional group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The amount of hematoma in the minimally invasive group was lower at 1 and 3 days after surgery than in the traditional group(P<0.05).The levels of serum GSH-Px and SOD in the 2 groups were lower than those before the operation on the 1st and 3rd day after the operation,but the minimally invasive group was higher than the traditional group.The serum MDA level was higher than that before operation,but the minimally invasive group was lower than the traditional group(P<0.05).After 6 months of follow-up,there were no cases of shedding.The BI and QLQ-C30 in the 2 groups were improved at 6 months after the operation compared with those before the operation,and the minimally invasive group was higher than the traditional group.The NIHSS score was lower than that before operation,and the minimally invasive group was lower than that of the traditional group(P<0.05).The prognosis of the minimally invasive group was better than that of the traditional group(P<0.05).Conclusion Patients with hypertensive intracerebral hemorrhage in the basal ganglia are treated with minimally invasive drilling and drainage,with less intraoperative blood loss and shorter operation time,and can reduce the expression of serum GSH-Px,MDA,SOD,restore nerve function,help improve the ability of daily living and quality of life,and improve the prognosis of patients.