神经内镜下与开颅手术治疗高血压脑出血的对比研究

Clinical comparative study of neuroendoscopy and craniotomy in the treatment of hypertensive cerebral hemorrhage

目的:对神经内镜下与开颅手术治疗高血压脑出血的临床效果进行对比分析。方法:选取2018年4月至2020年4月临汾市人民医院神经外科收治的108例高血压脑出血患者,男57例,女51例,年龄(58.12±4.25)岁,年龄范围为46~71岁。按照手术方法不同分为神经内镜组(n=60)与开颅手术组(n=48),比较两组患者围术期指标、治疗前后内皮素、C反应蛋白(CRP)、白细胞介素6(IL-6)、术后并发症发生率及术后随访6个月的预后。结果:神经内镜组血肿清除率[(89.21±6.15)%]高于开颅手术组[(73.53±4.66)%]、手术时间[(2.12±1.08)h]短于开颅手术组[(5.78±1.14)h]、术中出血量[(99.54±30.57)ml]少于开颅手术组[(261.36±12.98)ml]、术后重症监护室(ICU)时间[(7.24±2.31)d]短于开颅手术组[(11.35±2.25)d]、术后24 h内格拉斯哥昏迷指数(GCS)评分[(12.96±1.52)分]高于开颅手术组[(11.30±1.26)分]、住院时间[(31.50±3.41)d]短于开颅手术组[(39.48±4.25)d];治疗后,神经内镜组治疗后内皮素[(67.96±8.77)ng/L]、CRP[(15.11±2.83)mg/L]及IL-6[(23.45±3.62)μg/L]水平均低于开颅手术组[(85.41±10.54)ng/L、(21.58±3.65)mg/L、(42.25±5.11)μg/L],差异均有统计学意义(P<0.05)。神经内镜组术后并发症发生率[3.3%(2/60)]低于开颅手术组[18.8%(9/48)],差异有统计学意义(χ^(2)=5.346,P=0.021)。神经内镜组预后恢复良好[65.0%(39/60)]高于开颅手术组[45.8%(22/48)],差异有统计学意义(χ^(2)=4.257,P=0.035)。结论:神经内镜治疗高血压脑出血可获得更好的围术期指标,术后并发症发生率较低,且随访期间预后更好。

Objective:To explore and analyze the clinical effects of neuroendoscopy and craniotomy in the treatment of hypertensive cerebral hemorrhage.Methods:A total of 108 patients with hypertensive cerebral hemorrhage admitted to the department of Neurosurgery of Linfen People′s Hospital from April 2018 to April 2020 were selected.There were 57 males and 51 females,aged(58.12±4.25)years old,and the age range was 46 to 71 years,According to different surgical methods,they were divided into neuroendoscopy group(n=60)and craniotomy group(n=48).The two groups were compared with perioperative indicators,endothelin,C-reactive protein(CRP),interleukin-6(IL-6),the incidence of postoperative complications before and after treatment,and the prognosis of the 6-month follow-up.Results:The clearance rate of hematoma in the neuroendoscopy group[(89.21±6.15)%]was higher than that of the craniotomy group[(73.53±4.66)%],and the operation time[(2.12±1.08)h]was shorter than that of the craniotomy group[(5.78±1.14)h],intraoperative blood loss[(99.54±30.57)ml]less than craniotomy group[(261.36±12.98)ml],postoperative intensive care unit(ICU)time[(7.24±2.31)d]short In the craniotomy group[(11.35±2.25)d],the Glasgow Coma Index(GCS)score[(12.96±1.52)points]was higher than that in the craniotomy group[(11.30±1.26)points],within 24 hours after operation.The length of hospital stay[(31.50±3.41)d]was shorter than that of the craniotomy group[(39.48±4.25)d];after treatment,endothelin[(67.96±8.77)ng/L],CRP[(15.11±2.83)mg/L]and IL-6[(23.45±3.62)μg/L]are lower than the craniotomy group[(85.41±10.54)ng/L,(21.58±3.65)mg/L,(42.25±5.11)μg/L],the differences were statistically significant(P<0.05).The incidence of postoperative complications in the neuroendoscopy group[3.3%(2/60)]was lower than that in the craniotomy group[18.8%(9/48)],and the difference was statistically significant(χ^(2)=5.346,P=0.021).The neuroendoscopy group had a good prognosis[65.0%(39/60)]higher than that of the craniotomy group[45.8%(22/48)],and the difference was statistically significant(χ^(2)=4.257,P=0.035).Conclusion:Neuroendoscopic treatment of hypertensive cerebral hemorrhage can obtain better perioperative indicators,lower postoperative complications,and better prognosis during follow-up.