颅内血肿微创清除术和开颅手术治疗高血压脑出血的效果比较

Comparison on clinical effect of minimally invasive removal of intracranial hematoma versus craniotomy in the treatment of hypertensive cerebral hemorrhage

目的比较颅内血肿微创清除术和开颅手术治疗高血压脑出血的临床效果。方法回顾性分析2015年1月至2021年7月驻马店市第一人民医院收治的高血压性脑出血患者236例,将其中2015年1月至2018年7月采用开颅手术的124例患者作为开颅组,2018年8月至2021年7月采用颅内血肿微创清除术的112例患者作为微创组。对比两组临床效果、围术期情况、颅内压(ICP)及Fugl-Meyer运动功能测评法(FMA)评分、美国国立卫生研究院脑卒中量表(NIHSS)、Barthel指数(BI)评分及并发症发生率。结果微创组总有效率(90.18%,101/112)高于开颅组(79.84%,99/124),P<0.05;微创组血肿消失时间、手术时间及住院时间均较开颅组短(P均<0.05);微创组FMA分值较开颅组高(P<0.05);治疗后,微创组NIHSS评分较开颅组低,BI评分较开颅组高(P<0.05);微创组并发症发生率(9.82%,11/112)与开颅组(12.10%,15/124)比较差异未见统计学意义(P>0.05)。结论与开颅手术相比,针对高血压脑出血患者采用颅内血肿微创清除术可提高治疗效果,改善围术期情况,利于恢复上肢功能、神经功能,增强生活自理能力,且并发症发生率低。

Objective To compare the clinical effects of minimally invasive removal of intracranial hematoma and craniotomy in the treatment of hypertensive cerebral hemorrhage.Methods A total of 236 patients with hypertensive cerebral hemorrhage treated in Zhumadian First People’s Hospital from January 2015 to July 2021 were retrospectively analyzed.Among them,124 patients who underwent craniotomy in the hospital from January 2015 to July 2018 were selected as the craniotomy group,and 112 patients who underwent minimally invasive removal of intracranial hematoma from August 2018 to July 2021 were selected as the minimally invasive group.Clinical effects,perioperative conditions,intracranial pressure(ICP)and Fugl-Meyer assessment(FMA)scores,the American National Institute of Health Stroke Scale(NIHSS)score,Barthel index(BI)score and incidence of complications were compared between the two groups.Results The total effective rate in minimally invasive group was 90.18%(101/112),which was higher than the 79.84%(99/124)in craniotomy group(P<0.05).The time of hematoma disappearance,operation time and hospital stay in minimally invasive group were shorter than those in craniotomy group(all P<0.05).The FMA score of minimally invasive group was higher than that of craniotomy group(P<0.05).After treatment,NIHSS score in the minimally invasive group was lower,and BI score was higher,compared with those in the craniotomy group(P<0.05).There was no significant difference in complication rate between minimally invasive group(9.82%,11/112)and craniotomy group(12.10%,15/124),P>0.05.Conclusions Compared with craniotomy,minimally invasive removal of intracranial hematoma for patients with cerebral hypertensive hemorrhage can improve the therapeutic effect,improve the perioperative situation,restore upper limb function,nerve function,enhance their self-care ability,with low rate of complications.