显微外科手术治疗原发性脑干出血疗效观察

Effect of microsurgery for primary brainstem hemorrhage

目的探讨显微外科手术治疗原发性脑干出血的临床疗效。方法回顾性分析2017年1月至2020年12月新乡医学院第一附属医院收治的43例原发性脑干出血患者的临床资料,其中23例患者采用显微外科手术治疗(观察组),另20例患者采用保守治疗(对照组)。分别于治疗前和治疗后采用美国国立卫生研究院卒中量表(NHISS)评估2组患者神经功能缺损情况,采用日常生活能力量表(ADL)评估患者日常生活能力。治疗后6个月,采用格拉斯哥预后评分(GOS)评估2组患者治疗效果。结果治疗前观察组与对照组患者NHISS评分比较差异无统计学意义(P>0.05)。治疗后2组患者NHISS评分均显著低于治疗前(P<0.05)。治疗后,观察组患者NHISS评分显著低于对照组(P<0.05)。治疗前观察组与对照组患者ADL评分比较差异无统计学意义(P>0.05)。治疗后,2组患者ADL评分均显著高于治疗前(P<0.05)。治疗后,观察组患者ADL评分显著高于对照组(P<0.05)。观察组和对照组患者治疗有效率分别为34.8%(8/23)、15.0%(3/20),观察组患者治疗有效率显著高于对照组(χ^(2)=4.492,P<0.05);观察组和对照组患者的病死率分别为21.7%(5/23)、55.0%(11/20),观察组患者病死率显著低于对照组(χ^(2)=5.065,P<0.05)。结论显微外科手术治疗原发性脑干出血可以有效清除血肿,部分患者能取得相对良好的临床疗效。

Objective To investigate the clinical effect of microsurgery for primary brainstem hemorrhage.Methods The clinical data of 43 patients with primary brainstem hemorrhage admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2017 to December 2020 were retrospectively analyzed.Among them,twenty-three patients were treated with microsurgery(observation group),and 20 patients were treated with conservative treatment(control group).The neurologic impairment of patients in the two groups was evaluated by the National Institutes of Health Stroke Scale(NHISS)before and after treatment.The daily living ability of patients in the two groups was evaluated by activity of daily living(ADL).The treat ment effectiveness was evaluated by Glasgow outcome scale(GOS)at 6 months after treatment.Results There was no significant difference in NHISS score of patients between the observation group and the control group before treatment(P>0.05).The NHISS score of patients in the two groups after treatment was significantly lower than that before treatment(P<0.05).After treatment,the NHISS score of patients in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in ADL score of patients between the observation group and the control group before treatment(P>0.05).The ADL score of patients in the two groups after treatment was significantly higher than that before treatment(P<0.05).After treatment,the ADL score of patients in the observation group was significantly higher than that in the control group(P<0.05).The effective rate of patients in the observation group and the control group was 34.8%(8/23)and 15.0%(3/20),respectively.The effective rate of patients in the observation group was significantly higher than that in the control group(χ^(2)=4.492,P<0.05).The mortality of patients in the observation group and the control group was 21.7%(5/23)and 55.0%(11/20),respectively.The mortality of patients in the observation group was significantly lower than that in the control group(χ^(2)=5.065,P<0.05).Conclusion Microsurgery can effectively remove hematoma of patients with primary brianstem hemorrhage and some patients can achieve relatively good clinical efficacy.