亚急性硬膜下血肿患者应用开颅手术与微创钻孔引流手术治疗的临床效果分析

Analysis of Clinical Effect of Craniotomy and Minimally Invasive Drilling and Drainage in Patients with Subacute Subdural Hematoma

目的探讨开颅手术与微创钻孔引流手术治疗亚急性硬膜下血肿的临床疗效及对患者预后的影响。方法选取2020年6月—2021年6月78例亚急性硬膜下血肿患者,在“系统抽样法”原则下分对照组(行开颅血肿清除术)和观察组(行微创钻孔引流术),各39例。比较手术相关指标、术后并发症率、炎症因子水平、神经功能缺损情况、术后生活质量。结果观察组手术用时、术后引流及住院时间相比于对照组均更短,术后出血量及血肿残留量相比于对照组均更低,同时术后并发症率7.69%明显低于对照组25.64%,差异有统计学意义(P<0.05);治疗后,观察组较对照组血清C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)水平更低,差异有统计学意义(P<0.05);随访3、6个月,观察组神经功能缺损评分(NIHSS)分别为(4.08±1.11)分、(3.07±0.87)分均低于对照组(5.59±1.22)分、(4.58±1.14)分,差异有统计学意义(t=5.717、6.575,P<0.05);观察组生活质量量表(SF-36)各维度评分高于对照组,差异有统计学意义(P<0.05)。结论实施微创钻孔引流手术治疗亚急性硬膜下血肿,相较开颅手术,手术创伤及对患者的刺激性相对小,降低炎症因子水平,同时并发症风险小,促进患者康复及改善预后。

Objective To investigate the clinical efficacy of craniotomy and minimally invasive drilling and drainage in the treatment of subacute subdural hematoma and its influence on the prognosis of patients.Methods From June2020 to June 2021,78 patients with subacute subdural hematoma in People’s Hospital of Changle County of Shandong Province were selected and divided into the control group(with craniotomy hematoma removal)and the observation group(with minimally invasive drilling and drainage)under the principle of"systematic sampling",39 cases in each group.Comparison of surgery-related indicators,postoperative complication rates,inflammatory factor levels,neurological deficits,and postoperative quality of life.Results Compared with the control group,the observation group had shorter operation time,postoperative drainage and hospital stay,lower postoperative bleeding volume and hematoma residual volume,and the postoperative complication rate of 7.69%was significantly lower than that of the control group(25.64%),the difference was statistically significant(P<0.05).After treatment,the serum levels of Creactive protein(CRP)and tumor necrosis factor(TNF-α)in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Followed up for 3 months and 6 months,the neurological deficit score of NIHSS was(4.08±1.11)points,(3.07±0.87)points of the observation group,which were lower than the control group(5.59±1.22)points and(4.58±1.14)points,and the difference was statistically significant(t=5.717,6.575,P<0.05);the scores of each dimension of the quality of life scale(SF-36)in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with craniotomy,minimally invasive drilling and drainage surgery for the treatment of sub-acute subdural hematoma,the surgical trauma and irritation to the patient are relatively small,the level of inflammatory factors is reduced,and the risk of complications is small,which promotes the recovery of patients and improves the prognosis.