小骨窗开颅术与传统大骨瓣开颅术治疗高血压脑出血疗效观察

Observation on efficacy of small bone window craniotomy and traditional large bone flap craniotomy on hypertensive intracerebral hemorrhage

目的探讨小骨窗开颅术与传统大骨瓣开颅术治疗高血压脑出血的临床疗效。方法将82例高血压脑出血患者按手术方法分为两组,研究组(44例)实施小骨窗开颅术,对照组(38例)实施传统大骨瓣开颅术。比较两组住院时间及血肿清除率,比较术后1 d~7 d两组颅内压水平。术后30 d采用格拉斯哥预后量表评定两组预后情况,术前及术后3个月末采用美国国立卫生研究院卒中量表及改良Rankin量表评定两组神经功能。结果研究组住院时间显著短于对照组(P<0.01),两组血肿清除率及术后1 d~7 d颅内压比较差异无统计学意义(P>0.05)。术后30 d研究组格拉斯哥预后评分优良率显著高于对照组(P<0.05),术后3个月末两组美国国立卫生研究院卒中量表及改良Rankin量表评分均较术前显著降低(P<0.01),研究组较对照组下降更显著(P<0.01)。结论与大骨瓣开颅术相比,小骨窗开颅术治疗高血压脑出血患者血肿清除效果较好,手术创伤小,术后神经功能恢复好,康复时间短。

Objective To observe the efficacy of small bone window craniotomy and traditional large bone flap craniotomy on hypertensive intracerebral hemorrhage.Methods A total of 82 patients with hypertensive intracerebral hemorrhage were divided into two groups according to the surgical method.The study group(44 cases)underwent small bone window craniotomy,and the control group(38 cases)underwent traditional large bone flap craniotomy.The hospital stay and hematoma clearance rate were compared between the two groups,and the intracranial pressure levels were compared between the two groups from 1 d to 7 d after operation.The Glasgow outcome scale(GOS)was used to evaluate the prognosis of the two groups at 30 d after operation,and the neurological function of the two groups was evaluated by the National Institute of Health stroke scale(NIHSS)and the modified Rankin scale(mRS)before operation and at the end of 3 months after operation.Results The hospital stay in the study group was significantly shorter than that in the control group(P<0.01).There were no significant differences in the hematoma clearance rate and intracranial pressure at 1 d to 7 d after surgery between the two groups(P>0.05).The excellent and good rate of GOS in the study group was significantly higher than that in the control group 30 days after operation(P<0.05).At the end of 3 months after operation,the NIHSS and mRS scores of the two groups were significantly lower than those before operation(P<0.01),and the decrease in the study group was more significant than that in the control group(P<0.01).Conclusions Compared with large bone flap craniotomy,small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage patients has better hematoma removal effect,less surgical trauma,better postoperative neurological function recovery,and shorter recovery time.