神经内镜血肿清除术与开颅血肿清除术治疗重型脑室出血的临床观察

Clinical observation on the treatment of severe intraventricular hemorrhage with endoscopic hematoma removal and craniotomy hematoma removal

目的 探讨神经内镜血肿清除术与开颅血肿清除术治疗重型脑室出血的临床疗效。方法选择2017-01—2021-11内江市第二人民医院收治的重型脑室出血患者112例为研究对象。A组(n=56)采用神经内镜血肿清除术治疗,B组(n=56)采用开颅血肿清除术治疗,比较2组手术情况、血肿清除率、日常生活能力和不良反应情况。结果 A组手术时间(1.21±0.68)h、术中失血量(33.14±6.21)mL、血肿清除时间(5.38±1.25)d、脑脊液恢复时间(8.36±1.25)d、置管时间(2.03±0.62)d均少于B组;A组患者术后GCS评分(12.85±0.68)分、术后GOS评分(3.68±0.41)分高于B组;A组术后1个月残余血肿体积为(2.18±0.47)mL,低于B组的(13.31±1.78)mL,差异有统计学意义(P<0.05)。2组术后3个月复发率比较差异无统计学意义(P>0.05)。A组治疗后1周的NIHSS评分为(7.09±1.93)分,低于B组的(11.98±2.79)分;A组不良反应发生率5.36%,低于B组的14.29%,差异有统计学意义(P<0.05)。结论 神经内镜血肿清除术治疗重型脑室出血的临床效果良好,可有效缩短手术时间,降低不良反应发生率,安全性高。

Objective To investigate the clinical efficacy of endoscopic hematoma removal and craniotomy hematoma removal in the treatment of severe intraventricular hemorrhage.Methods Totally 112 patients with severe intraventricular hemorrhage treated in Neijiang Second People’s Hospital from January 2017 to November 2021 were selected.According to the random number table method,56 cases were divided into two groups.Group A was treated with endoscopic hematoma removal,and group B was treated with craniotomy hematoma removal.The surgical conditions,hematoma removal rate,activities of daily living and adverse reactions were compared between the two groups.Results The operation time(1.21±0.68)h,intraoperative blood loss(33.14±6.21)ml,hematoma clearance time(5.38±1.25)d,cerebrospinal fluid recovery time(8.36±1.25)D and catheterization time(2.03±0.62)d in group A were less than those in group B;The postoperative GCS score(12.85±0.68)and postoperative gos score(3.68±0.41)of group A were higher than those of group B;One month after operation,the volume of residual hematoma in group A was(2.18±0.47)mL,which was lower than that in group B(13.31±1.78)mL,and the difference was statistically significant(P<0.05).There was no significant difference in the recurrence rate of 3 months after operation between the two groups.The NIHSS score of group A was(7.09±1.93)one week after treatment,which was lower than that of group B(11.98±2.79);The incidence of adverse reactions in group A was 5.36%,lower than 14.29%in group B,and the difference was statistically significant(P<0.05).Conclusion The clinical effect of endoscopic hematoma removal in the treatment of severe intraventricular hemorrhage is good,which can effectively shorten the operation time,reduce the incidence of adverse reactions,and have high safety.