锁孔清除术与穿刺抽吸术治疗基底节区高血压脑出血的效果比较

Comparison of effects of keyhole clearance and puncture aspiration in the treatment of hypertensive cerebral hemorrhage in basal ganglia

目的比较锁孔清除术与穿刺抽吸术治疗基底节区高血压脑出血(HCH)的效果。方法选取2018年2月至2020年2月我院神经外科收治的84例基底节区HCH患者为研究对象,按照手术方法不同将其分为锁孔清除术组(锁孔清除术)和穿刺抽吸术组(穿刺抽吸术),各42例。比较两组的围术期指标、BI及NIHSS评分、NSE水平、颅内压及术后并发症发生情况。结果锁孔清除术组的手术时间长于穿刺抽吸术组,术中出血量多于穿刺抽吸术组,引流管拔除时间、住院时间短于穿刺抽吸术组(P<0.05)。出院时,两组的BI评分均较入院时升高,NIHSS评分均较入院时降低,且锁孔清除术优于穿刺抽吸术组(P<0.05)。术后,两组的NSE水平及颅内压均较术前降低,且锁孔清除术组低于穿刺抽吸术组(P<0.05)。两组的术后并发症总发生率无显著差异(P>0.05)。结论锁孔清除术与穿刺抽吸术治疗基底节区HCH均可取得一定的效果。相比之下,锁孔清除术可更明显地缩短患者引流管拔除时间、住院时间,提高日常活动能力,改善神经功能,降低NSE水平及颅内压,适合在基层医院开展。

Objective To compare the effects of keyhole clearance and puncture aspiration in the treatment of hypertensive cerebral hemorrhage(HCH)in basal ganglia.Methods A total of 84 patients with HCH in basal ganglia treated in neurosurgery department of our hospital from February 2018 to February 2020 were selected as the research objects.According to different surgical methods,the patients were divided into keyhole clearance group(keyhole clearance)and puncture aspiration group(puncture aspiration),with 42 cases in each group.The perioperative indexes,BI and NIHSS scores,NSE level,intracranial pressure and postoperative complications were compared between the two groups.Results The operation time of the keyhole clearance group was longer than that of the puncture aspiration group,the intraoperative bleeding volume was more than that of the puncture aspiration group,and the drainage tube extraction time and hospital stay were shorter than those of the puncture aspiration group(P<0.05).At discharge,the BI score of the two groups were higher than those at admission,the NIHSS score were lower than those at admission,and those of the keyhole clearance group were better than the puncture aspiration group(P<0.05).After operation,the NSE level and intracranial pressure in the two groups were lower than those before operation,and those in the keyhole clearance group were lower than the puncture aspiration group(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion Both keyhole clearance and puncture aspiration in the treatment of HCH in basal ganglia can achieve certain results.In contrast,keyhole clearance can significantly shorten the drainage tube extraction time and hospital stay,improve the ability of daily activities,ameliorate neurological function,reduce NSE level and intracranial pressure,which is suitable to be carried out in grass-roots hospitals.