不同时期小骨窗显微手术治疗基底节高血压脑出血的效果

Effect of Different Periods Small Bone Window Microscopic Operation in the Treatment of Hypertensive Cerebral Hemorrhage in Basal Ganglia

目的:探究不同时期小骨窗显微手术治疗基底节高血压脑出血(HICH)的效果。方法:回顾性分析2020年10月—2022年10月贵航贵阳医院神经外科诊断治疗的95例基底节HICH患者的临床资料。根据发病至手术时间将其分为超早期组(n=33)、早期组(n=32)和晚期组(n=30)。超早期组、早期组、晚期组分别在<6 h、6~24 h、>24 h给予小骨窗显微手术治疗。比较三组围手术期指标,术前和术后7 d、14 d昏迷情况,术后并发症,术后3个月死亡率、预后情况、生活能力。结果:超早期组的手术时间和住院时间明显短于早期组和晚期组,早期组的手术时间和住院时间明显短于晚期组,差异有统计学意义(P<0.05)。术后7 d、14 d,超早期组的格拉斯哥昏迷量表评分(GCS)评分明显高于早期组和晚期组;早期组的GCS评分高于晚期组,差异有统计学意义(P<0.05)。超早期组的术后并发症发生率明显低于早期组和晚期组,差异有统计学意义(P<0.05)。三组术后3个月死亡率比较差异无统计学意义(P>0.05)。超早期组术后3个月的格拉斯哥预后量表(GOS)优良率、日常生活能力量表(ADL)评分均高于早期组和晚期组,早期组术后3个月的GOS优良率、ADL评分均高于晚期组,差异有统计学意义(P<0.05)。结论:基底节HICH患者发病后6 h内行小骨窗显微手术治疗具有更好的临床效果,可明显缩短患者住院时间,促进患者恢复,降低术后并发症的发生率,提高预后质量。

Objective:To investigate the effect of different periods small bone window microscopic operation in the treatment of hypertensive cerebral hemorrhage(HICH)in basal ganglia.Method:The clinical data of 95 patients with basal ganglia HICH diagnosed and treated in Neurosurgery Department of Guihang Guiyang Hospital from October 2020 to October 2022 were prospectively analyzed.According to the time from onset to operation,the patients were divided into super early group(n=33),early group(n=32)and late group(n=30).Super early group,early group and late group were given small bone window microscopic operation at<6 h,6~24 h and>24 h respectively.Perioperative indexes,coma condition before operation,7 d and 14 d after operation,postoperative complications,mortality,prognosis condition and living ability 3 months after operation were compared among the three groups.Result:The operation time and hospital stay in the super early group were significantly shorter than those in the early group and late group,and the operation time and hospital stay in the early group were significantly shorter than those in the late group,the differences were statistically significant(P<0.05).The Glasgow coma scale score(GCS)in the super early group was significantly higher than that in the early group and late group at 7 d and 14 d after operation,the GCS score in the early group was higher than that in the late group,the differences were statistically significant(P<0.05).The incidence of postoperative complications in the super early group was significantly lower than those in the early group and the late group,and the difference was statistically significant(P<0.05).There was no significant difference in mortality rate at 3 months after operation among the three groups(P>0.05).The Glasgow outcome scale(GOS)excellent and good rate and daily living ability scale(ADL)score of the super early group at 3 months after operation were higher than those of the early group and the late group,and the GOS excellent and good rate and ADL score of the early group at 3 months after operation were higher than those of the late group,the differences were statistically significant(P<0.05).Conclusion:Small bone window microscopic operation treatment for patients with HICH in the basal ganglia within 6 h of onset has better clinical efficacy,can significantly shorten the length of hospitalization of patients,promote patient recovery,reduce the incidence of postoperative complications,and improve the quality of prognosis.