不同定位方法的经皮锥颅软通道引流术与常规开颅手术对高血压脑出血患者手术指标及神经功能的影响

Influence of percutaneous cranial soft channel drainage and conventional craniotomy with different localization methods on surgical indicators and nerve function of patients with hypertensive cerebral hemorrhage

目的探讨不同定位方法的经皮锥颅软通道引流术与常规开颅手术对高血压脑出血(Hypertensive Intracerebral Hemorrhage,HICH)患者手术指标及神经功能的影响。方法选取2018年1月至2020年5月本院收治的经皮锥颅软通道引流术治疗的HICH患者80例,按照定位方式的不同分为3D-slicer软件定位组(A组)、CT定位组(B组),各40例,另外选取同时期经常规开颅手术治疗的HICH患者40例为C组,观察3组患者手术指标、神经功能的差异。结果A组患者手术时间为(76.27±11.29)min、术中出血量为(77.26±11.36)ml、住院时长为(14.30±4.11)d,B组分别为(103.24±16.96)min、(115.45±21.26)ml、(15.70±4.78)d,C组分别为(149.75±10.32)min、(165.88±23.70)ml、(18.66±4.38)d,3组患者手术时间、术中出血量、住院时长比较,差异均有统计学意义(均P<0.05)。A组患者穿刺成功率(40/40,100.00%)明显高于B组(35/40,87.50%),P<0.05;3组患者术前血肿量比较,差异无统计学意义(P>0.05),术后A组血肿量为(4.34±0.92)ml、血肿清除率为(90.86±2.35)%,B组分别为(8.57±1.94)ml、(81.36±3.55)%,C组分别为(12.78±1.83)ml、(78.89±2.14)%,3组患者在术后血肿量、血肿清除率上比较差异均有统计学意义(均P<0.05)。术前3组NIHSS评分、S100β蛋白、NSE水平比较,差异均无统计学意义(均P>0.05);术后3组NIHSS评分、S100β蛋白、NSE水平比较,差异均有统计学意义(均P<0.05),并且NIHSS评分、S100β蛋白、NSE水平比较:A组<B组<C组。结论3D-slicer软件定位经锥颅软通道引流术治疗高血压脑出血患者,治疗效果明显,术中安全性高,有利于患者术后神经功能改善。

Objective To investigate the effects of percutaneous cranial soft channel drainage and conventional craniotomy with different localization methods on the surgical indicators and nerve function of patients with hypertensive intracerebral hemorrhage(HICH).Methods Eighty patients with HICH treated by percutaneous cranial soft channel drainage at our hospital from January,2018 to May,2020 were selected.According to different positioning methods,the patients were divided into a 3D-SLicer software positioning group(group A)and a CT positioning group(group B),with 40 cases in each group.In addition,40 HICH patients treated by conventional craniotomy during the same period were selected as group C.Results The operation time,intraoperative bleeding volume,and hospital stay were(76.27±11.29)min,(77.26±11.36)ml,and(14.30±4.11)d in group A,were(103.24±16.96)min,(115.45±21.26)ml,and(15.70±4.78)d in group B,and were(149.75±10.32)min,(165.88±23.70)ml,and(18.66±4.38)d,with statistical differences between the three groups(all P<0.05).The success rate of puncture in group A was significantly higher than that in group B[100.00%(40/40)vs.87.50%(35/40),P<0.05].There was no significant difference in preoperative hematoma volume between the three groups(P>0.05).After the operation,the hematoma volume and the hematoma clearance rate were(4.34±0.92)ml and(90.86±2.35)%in group A,were(8.57±1.94)ml and(81.36±3.55)%in group B,and were(12.78±1.83)ml and(78.89±2.14)%in group C,with statistical differences between the 3 groups(all P<0.05).The NIHSS score and levels of S100βprotein and NSE in group A<those in group B<those in group C,with statistical differences between the 3 groups(all P<0.05).Conclusion 3D-SLicer software is positioned to treat patients with HICH through cone-cranial soft channel drainage,with obvious therapeutic effect and high intraoperative safety,which is conducive to the improvement of patients'postoperative nerve function.