早期小骨窗开颅治疗高血压基底节区脑出血的效果研究

Clinical effect of early small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage in basal ganglia

目的研究临床早期小骨窗开颅治疗高血压基底节区脑出血的应用价值。方法将2015年1月至2021年1月神经外科手术治疗的高血压基底节区脑出血患者116例随机分为2组,每组58例。对照组使用传统大骨瓣开颅手术,观察组使用早期小骨窗开颅手术,比较2组血肿清除率及再出血率、各项手术及恢复指标、临床疗效、并发症发生率、术后日常生活能力。结果观察组消除血肿率高于对照组,复发出血率明显低于对照组,差异有统计学意义(P<0.05),2组住院期间死亡率比较差异无统计学意义(P>0.05);观察组手术指标包括住院时间、住院费用明显少于对照组,术后GCS评分、MMSE评分较对照组优良,差异有统计学意义(P<0.05);观察组治疗有效率为94.83%,明显高于对照组的79.31%,差异有统计学意义(P<0.05);观察组术后机体感染并发症发生率明显低于对照组(P<0.05);观察组术后4周ADL分级Ⅰ级、Ⅱ级比例、预后良好率明显高于对照组,Ⅲ~Ⅴ级比例明显低于对照组(P<0.05)。结论早期小骨窗开颅能够提高血肿清除率,再出血率低,并发症发生率低,恢复效果好,有助于神经功能的恢复和改善预后,是一种高效、安全的术式选择。

Objective To investigate the clinical value of small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage in basal ganglia.Methods A total of 116 patients with hypertensive cerebral hemorrhage who were treated by surgery in our hospital from January 2015 to January 2021 were randomly divided into two groups,with 58 cases in each group.The patients in control group were treated by traditional large bone flap craniotomy,however,thepatients in observation group were treated by early small bone window craniotomy.The hematoma clearance rate,rebleeding rate,various surgical and recovery indicators,clinical efficacy,incidence of complications,postoperative activities of daily living(ADL)were observed and compared between the two groups.Results The hematoma clearance rate in observation group was significantly higher than that in control group,while the rate of recurrent bleeding was significantly lower than that in control group(P<0.05).There was no significant difference in mortality during hospitalization between the two groups(P>0.05)The length of hospitalization and hospitalization expenses in observation group were significantly less than those in control group,and the postoperative GCS scores and MMSE scores were superior to those in control group(P<0.05).The effective rate in observation group was 94.83%,which was significantly higher than that(79.31%)in control group(P<0.05).The incidence rate of postoperative infection complications in observation group was significantly lower than that in control group(P<0.05).The proportion of ADL gradeⅠ,gradeⅡ,and good prognosis rate at 4 weeks after operation in observation group was significantly higher than that in control group,while the proportion of gradesⅢtoⅤwas significantly lower than that in control group(P<0.05).Conclusion Early small bone window craniotomy can improve the hematoma clearance rate,lower rebleeding rate and incidence of complication,has good recovery effect,and is conductive to the recovery of nerve function and improvement in the prognosis.Therefore,it is an efficient and safe surgical option.