神经内镜辅助去骨瓣血肿清除术治疗高血压脑出血的效果及对患者神经功能、预后的影响

Effectiveness of Neuroendoscope-assisted Decompressive Craniectomy and Hematoma Evacuation in Treatment of Patients with Hypertensive Intracerebral Hemorrhage and Its Effects on Neurological Function and Prognosis

目的探讨神经内镜辅助去骨瓣血肿清除术治疗高血压脑出血的效果及对患者神经功能、预后的影响。方法选取2018年2—10月收治的高血压脑出血92例,根据手术方法不同将其分为观察组(48例)和对照组(44例)两组。观察组予神经内镜辅助去骨瓣血肿清除术治疗,对照组予去骨瓣开颅血肿清除术治疗。比较两组手术指标、血肿清除情况、神经功能评分、预后情况和并发症发生情况。结果观察组手术时间长于对照组,术中出血量少于对照组,住院时间短于对照组,血肿清除率高于对照组,差异有统计学意义(P<0.01)。术前,两组美国国立卫生研究院卒中量表(NIHSS)和格拉斯哥预后量表(GOS)、日常生活活动能力(ADL)量表评分比较差异无统计学意义(P>0.05)。术后1周,两组NIHSS评分均较术前降低,且观察组NIHSS评分低于对照组,差异有统计学意义(P<0.01)。术后3个月,两组GOS和ADL量表评分均高于术前,且观察组GOS和ADL量表评分高于对照组,差异有统计学意义(P<0.01)。术后3个月内,并发症总发生率观察组低于对照组,差异有统计学意义(P<0.05)。结论神经内镜辅助去骨瓣血肿清除术治疗高血压脑出血患者术中出血量少,住院时间短,可提高血肿清除率,改善神经功能及预后,且术后并发症总发生率低。

Objective To investigate effectiveness of neuroendoscope-assisted decompressive craniectomy and hematoma evacuation in treatment of patients with hypertensive intracerebral hemorrhage(HICH)and its effects on neurological function and prognosis.Methods A total of 92 HICH patients admitted during February 2018 and October 2018 were selected and divided into observation group(n=48)and control group(n=44)according to different surgical methods.Observation group was treated with neuroendoscope-assisted decompressive craniectomy and hematoma evacuation,while control group was treated with conventional decompressive craniectomy and hematoma evacuation.Operation-related indexes,hematoma clearance,neurological function score,prognosis condition and incidence rate of complications were compared between two groups.Results In observation group,values of operative duration and hematoma clearance rate were significantly higher,while values of intraoperative volume of blood loss and length of hospitalization were significantly lower than those in control group(P<0.01).There were no significant differences in scores of National Institute of Health stroke scale(NIHSS),Glasgow Outcome Scale(GOS)and activities of daily living(ADL)before operation between two groups(P>0.05).After operation for 1 week,NIHSS scores were significantly lower than those before operation in two groups,and NIHSS score in observation group was significantly lower than that in control group(P<0.01).After operation for 3 months,GOS and ADL scores were significantly higher than those before operation in two groups,and the scores in observation group were significantly higher than those in control group(P<0.01).The total incidence rate of complications in observation group was significantly lower than that in control group within 3 months after operation(P<0.05).Conclusion Neuroendoscope-assisted decompressive craniectomy and hematoma evacuation in treatment of HICH patients may achieve less intraoperative volume of blood loss and shorter hospital stay,and it may improve hematoma clearance rate,neurological function and prognosis,and the total incidence rate of postoperative complications is also low.