小骨窗开颅显微手术治疗幕上高血压脑出血的临床效果

Clinical effect of microsurgery with small bone window craniotomy in the treatment of supratentorial hypertensive intracerebral hemorrhage

目的探究小骨窗开颅显微手术治疗幕上高血压脑出血(HICH)的临床效果。方法收集2019年7月至2020年6月于我院就诊的64例幕上HICH患者的临床资料,根据随机数字表法将患者分为对照组和观察组,各32例。对照组进行传统大骨瓣开颅手术,观察组进行小骨窗开颅显微手术。比较两组患者的围手术期指标、脑血流动力学指标、预后情况、认知功能、并发症发生情况及死亡情况。结果观察组的手术时长、ICU入住时长短于对照组(P<0.05)。手术后,两组的Vp、MFV均较手术前增大,RI均较手术前减小,且观察组优于对照组(P<0.05)。两组手术后4周的FMA评分均较手术前升高,手术后7 d的GCS评分均较手术前升高,手术后4周的ESS评分均较手术后2周升高,且观察组高于对照组(P<0.05)。观察组手术后2、4周的MoCA及MMSE评分明显高于对照组(P<0.05)。观察组的肺部感染发生率为6.25%,低于对照组的15.62%,差异具有统计学意义(P<0.05)。结论与大骨瓣开颅手术相比,小骨窗开颅显微手术应用在幕上HICH中具有手术时间短、肺部感染并发症少、预后情况好等优势,是一种安全、有效的手术方式。

Objective To explore the clinical effect of microsurgery with small bone window craniotomy in the treatment of supratentorial hypertensive intracerebral hemorrhage(HICH). Methods The clinical data of 64 patients with supratentorial HICH treated in our hospital from July 2019 to June 2020 were collected. According to the random number table method, the patients were divided into control group and observation group, with 32 cases in each group.The control group underwent traditional large bone flap craniotomy, and the observation group underwent microsurgery with small bone window craniotomy. The perioperative indexes, cerebral hemodynamics, prognosis, cognitive function,complications and death were compared between the two groups. Results The length of operation and ICU stay in the observation group were shorter than those in the control group(P <0.05). After operation, Vp and MFV of the two groups increased and RI decreased compared with those before operation, and those of the observation group were better than the control group(P<0.05). The FMA score at 4 weeks after operation of the two groups was higher than that before operation, the GCS score at 7 d after operation was higher than that before operation, the ESS score at 4 weeks after operation was higher than that at 2 weeks after operation, and those of the observation group were higher than the control group(P <0.05). The scores of MoCA and MMSE in the observation group at 2 and 4 weeks after operation were significantly higher than those in the control group(P<0.05). The incidence of pulmonary infection in the observation group was 6.25%, which was lower than 15.62% in the control group, and the difference was statistically significant(P<0.05).Conclusion Compared with large bone flap craniotomy, microsurgery with small bone window craniotomy applied in supratentorical HICH has the advantages of short operation time, less pulmonary infection complications and good prognosis, which is a safe and effective operation method.