微创锥颅穿刺血肿引流术与小骨窗开颅术治疗高血压脑出血对照研究

A control study on minimally invasive intracranial hematoma puncture drainage and small bone window craniotomy for treating hypertensive cerebral hemorrhage

目的探讨微创锥颅穿刺血肿引流术与小骨窗开颅术治疗高血压脑出血的疗效及安全性。方法将90例高血压脑出血患者按随机数字表法分为两组,各45例。对照组采用小骨窗开颅术治疗,观察组采用微创锥颅穿刺血肿引流术治疗,比较两组围术期指标、临床疗效、血肿清除量及并发症发生率,治疗前后两组血清炎性因子(C反应蛋白、肿瘤坏死因子-α、白细胞介素-6)水平、铁蛋白水平、P物质水平、美国国立卫生研究院卒中量表评分及日常生活能力量表评分。结果观察组手术时间、意识恢复时间及住院时间均显著短于对照组(P<0.01),术中出血量显著少于对照组(P<0.01)。术后1 d、3 d观察组血肿清除量显著少于对照组(P<0.01),术后7 d两组血肿清除量比较差异无统计学意义(P>0.05)。观察组治疗总有效率显著高于对照组(P<0.05),并发症发生率显著低于对照组(P<0.05)。治疗后观察组美国国立卫生研究院卒中量表评分显著低于对照组(P<0.01),日常生活能力量表评分显著高于对照组(P<0.01),血清C反应蛋白、肿瘤坏死因子-α、白细胞介素-6、P物质水平均显著低于对照组(P<0.01),铁蛋白水平显著高于对照组(P<0.01)。结论微创锥颅穿刺血肿引流术治疗高血压脑出血较小骨窗开颅术疗效更佳,可有效清除血肿,促进患者神经功能恢复,降低炎性因子水平,提高患者生活质量,安全性较高。

Objective To investigate the efficacy and safety of minimally invasive intracranial hematoma puncture drainage and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage(HICH).Methods A total of 90 patients with HICH were divided into two groups according to random number table method,with 45 cases in each group.The control group was treated with small bone window craniotomy,and the observation group was treated with minimally invasive intracranial hematoma puncture drainage.The perioperative indexes,clinical efficacy,hematoma clearance and complication rate of the two groups were compared.The levels of serum inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],serum ferritin(SF),substance P(SP),national institute of health stroke scale(NIHSS)and activity of daily living scale(ADL)were compared before and after treatment.Results The operation time,consciousness recovery time,length of hospital stay,and intraoperative blood loss of the observation group were significantly shorter/less than those of the control group(P<0.01).The amount of hematoma removed in observation group was significantly less than that in the control group on day 1 and day 3 after surgery(P<0.01).There was no significant difference in the amount of hematoma clearance between the two groups 7 d after surgery(P>0.05).The total effective rate in observation group was significantly higher than that in control group ( P <0.05), and the incidence of complications was significantly lower than that in control group ( P <0.05). After treatment, the NIHSS score of observation group was significantly lower than that of control group ( P <0.01), while ADL score was significantly higher than that of control group ( P <0.01). After treatment, the levels of serum CRP, TNF-α, IL-6 and SP in observation group were significantly lower than those in control group ( P <0.01), and SF level was significantly higher than that in control group ( P <0.01). Conclusions Minimally invasive intracranial hematoma puncture drainage is more effective than small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage. It can effectively remove hematoma, promote the recovery of neurological function, reduce the level of inflammatory factors, and improve the quality of life of patients, with higher safety.