基底节脑出血微创治疗与开颅手术应用于高血压脑出血患者的临床疗效

Clinical Effect of Minimally Invasive Treatment of Basal Ganglia Hemorrhage and Craniotomy on Hypertensive Cerebral Hemorrhage

目的研究基底节脑出血微创治疗与开颅手术对高血压脑出血患者的影响。方法根据治疗方法不同将焦作市第六人民医院2018年1月至2022年4月接收的62例高血压脑出血患者分为研究组和对照组,各31例。研究组开展基底节脑出血微创治疗,对照组实施开颅手术,手术后评价两组治疗有效率,记录失血量、手术时长、血肿清除、置管引流、住院时长,手术前后检测神经功能缺损(NIHSS)、日常生活能力(ADL)、生活质量,并对比手术前、手术后3 d、7 d、14 d两组的格拉斯哥昏迷指数(GCS)评分,统计并发症发生率(颅内感染、消化道出血、脑积水、下肢深静脉血栓),比较两组治疗结果。结果研究组治疗有效率(90.32%)高于对照组(67.74%),差异有统计学意义(P<0.05);研究组并发症发生率(12.90%)低于对照组(38.71%),差异有统计学意义(P<0.05)。研究组采用微创治疗,血肿清除、置管引流时间长于对照组,但手术时长、失血量、头皮切口、颅骨缺损、住院天数均少于对照组,差异有统计学意义(P<0.05)。两组手术前的NIHSS、ADL、生活质量评分差异无统计学意义(P>0.05),手术后研究组NIHSS评分低于对照组,ADL、生活质量评分高于对照组,差异有统计学意义(P<0.05)。两组手术前的GCS评分差异无统计学意义(P>0.05),手术后3 d、7 d、14 d研究组评分高于对照组(P<0.05)。结论虽然基底节脑出血微创治疗液化引流的时间较长,但微创穿刺手术准备时间短,局麻即可开展,且手术时间短,可快速释放少量血肿,缓解高颅压,稳定患者病情,经进一步血肿液化引流治疗,4~7 d清除血肿,拔除引流管。患者手术创伤小,术后恢复较快,缩短住院天数,同时患者意识恢复较快,也有利于早期康复,改善其神经功能及生活质量,值得借鉴。

Objective To study the effect of minimally invasive treatment and craniotomy on patients with hypertensive cerebral hemorrhage Methods According to different treatment methods,62 patients with hypertensive cerebral hemorrhage admitted to the Sixth People's Hospital of Jiaozuo City from January 2018 to April 2022 were divided into study group and control group,31 cases each.The study group received minimally invasive treatment for basal ganglia hemorrhage,while the control group received craniotomy.The treatment effective rate of the two groups was evaluated after surgery,and the blood loss,operation duration,hematoma removal,catheter drainage and length of hospital stay were recorded.The neurological deficit(NIHSS),ability of daily living(ADL)and quality of life were detected before and after surgery,and the Glasgow Coma Index(GCS)scores of the two groups were compared before surgery,3 d,7 d and 14 d after surgery.The incidence of complications(intracranial infection,gastrointestinal hemorrhage,hydrocephalus and deep venous thrombosis of lower extremities)was analyzed and the treatment results of the two groups were compared.Results The treatment effective rate of the study group(90.32%)was higher than that of the control group(67.74%),the difference was statistically significant(P<0.05).The complication rate of the study group(12.90%)was lower than that of the control group(38.71%),and the difference was statistically significant(P<0.05).The study group adopted minimally invasive treatment,and the time of hematoma removal and catheter drainage was longer than that of the control group,but the operation time,blood loss,scalp incision,skull defect and hospital stay were less than that of the control group,the difference was statistically significant(P<0.05).The NIHSS,ADL and quality of life scores of the two groups were not significantly different before surgery(P>0.05).After surgery,the NIHSS score of the study group was lower than that of the control group,while the ADL and quality of life score of the two groups were higher than that of the control group,with statistical significance(P<0.05).There was no significant difference in the GCS score between the two groups before operation(P>0.05),and the score of the study group was higher than that of the control group at 3,7 and 14 days after operation(P<0.05).Conclusion Although the time of liquefaction drainage for the minimally invasive treatment of basal ganglia hemorrhage is longer,the preparation time of minimally invasive puncture surgery is short,local anesthesia can be carried out,and the operation time is short,which can quickly release a small amount of hematoma,relieve high cranial pressure and stabilize the patient's condition.After further treatment of hematoma liquefaction drainage,the hematoma can be cleared and the drainage tube can be removed in 4~7 days.The patients have less surgical trauma,faster recovery after surgery,shorten the length of hospital stay,and faster recovery of consciousness,which is also conducive to early rehabilitation,improve their neurological function and quality of life,which is worth learning.