不同小骨窗显微手术时机治疗基底核高血压脑出血患者的效果比较

Comparison of effects of different small bone window microsurgery timing in treatment of patients with basal ganglia hypertensive cerebral hemorrhage

目的:比较不同小骨窗显微手术时机治疗基底核高血压脑出血患者的效果。方法:回顾性分析2019年1月至2020年12月该院收治的105例基底核高血压脑出血患者的临床资料,根据手术时机不同分为A、B和C组各35例。三组均进行小骨窗显微手术,A组发病至手术时间<7 h,B组发病至手术时间7~12 h,C组发病至手术时间>12 h,比较三组手术前后神经功能缺损程度[美国国立卫生研究院卒中量表(NIHSS)]评分、日常生活活动能力[日常生活活动能力量表(ADL)]评分、生命质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]评分、预后情况[格拉斯哥预后量表(GOS)]、术后3个月并发症发生率和再出血发生率。结果:术后3个月,三组NIHSS评分均低于术前,且A组<B组<C组,差异有统计学意义(P<0.05);三组ADL、WHOQOL-BREF评分均高于术前,且A组>B组>C组,差异有统计学意义(P<0.05);A组预后情况优于B、C组,B组预后情况优于C组,差异均有统计学意义(P<0.05);三组并发症发生率为A组低于B、C组,差异有统计学意义(P<0.05);三组术后再出血发生率比较,差异无统计学意义(P>0.05)。结论:发病7 h内实施小骨窗显微手术治疗基底核高血压脑出血患者可降低NIHSS评分和并发症发生率,提高ADL评分和WHOQOL-BREF评分,改善预后情况,效果优于发病7~12 h和>12 h手术治疗效果,且发病7~12 h手术治疗效果优于发病>12 h手术治疗。

Objective:To compare effects of different small bone window microsurgery timing in treatment of patients with basal ganglia hypertensive cerebral hemorrhage.Methods:The clinical data of 105 patients with basal ganglia hypertensive cerebral hemorrhage admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed.According to the different surgery timing,they were divided into groups A,B and C,35 cases in each group.Small bone window microsurgery was performed in all three groups.The time from onset to the surgery in group A was<7 hours,and those of group B and group C were 7-12 hours and>12 hours,respectively.The scores of neurological deficit[national institutes of health stroke scale(NIHSS)],the activities of daily living[activities of daily living scale(ADL)],and the quality of life[world health organization quality of life inventory-brief(WHOQOL-BREF)],the prognosis[Glasgow outcome scale(GOS)],the 3-month postoperative complication rate and the rebleeding rate were compared among the three groups before and after the surgery.Results:3 months after the surgery,the NIHSS scores of the three groups were all lower than those before the surgery,those of the three groups were:group A<group B<group C,and the differences were statistically significant(P<0.05).The ADL and WHOQOL-BREF scores of the three groups were higher than those before the surgery,those of the three groups were:group A>group B>group C,and the differences were statistically significant(P<0.05).The prognosis of group A was better than those of groups B and C,the prognosis of group B was better than that of group C,and the differences were statistically significant(P<0.05).The incidence of complications in the three groups was lower in group A than in groups B and C,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of postoperative rebleeding among the three groups(P>0.05).Conclusions:Small bone window microsurgery within 7 hours of onset can reduce the NIHSS score and the incidence of complications,improve the ADL score and the WHOQOL-BREF score,and improve the prognosis in the patients with basal ganglia hypertensive cerebral hemorrhage.Moreover,it is superior to the surgical treatments at 7-12 h and>12 h of onset,and the surgical treatment at 7-12 h of onset is superior to that>12 h of onset.