经外侧裂入路血肿清除术对高血压基底节区脑出血患者昏迷程度及预后的影响

Effect of Hematoma Removal through Lateral Fissure Approach on Coma Degree and Prognosis of Patients with Hypertensive Basal Ganglia Intracerebral Hemorrhage

目的:探讨经外侧裂入路血肿清除术对高血压基底节区脑出血患者昏迷程度及预后的影响。方法:选取2020年8月—2022年8月于龙岩人民医院就诊并接受治疗的128例高血压基底节区脑出血患者为受试对象,随机将其分为外侧裂组与颞叶皮层组,各64例。两组均实施血肿清除术治疗,颞叶皮层组经颞叶皮层入路进行手术,外侧裂组经外侧裂入路进行手术。比较两组围手术期指标(手术时间、手术出血量、住院时间、血肿清除率),比较两组术前及术后3 d、1周昏迷程度[格拉斯哥昏迷量表(GCS)]评分,观察两组术后1个月内并发症(肺部感染、脑疝、颅内再出血、癫痫)发生情况,比较两组术后3个月预后情况[格拉斯哥预后量表(GOS)]。结果:外侧裂组手术时间、住院时间显著短于颞叶皮层组,血肿清除率明显高于颞叶皮层组,手术出血量少于颞叶皮层组,差异有统计学意义(P<0.05)。术后3 d、术后1周时,两组GCS评分均显著高于术前,且外侧裂组高于颞叶皮层组,差异有统计学意义(P<0.05)。外侧裂组术后1个月内并发症发生率明显低于颞叶皮层组,差异有统计学意义(P<0.05)。外侧裂组术后3个月GOS评分显著优于颞叶皮层组,差异有统计学意义(P<0.05)。结论:经外侧裂入路血肿清除术治疗高血压基底节区脑出血效果显著,能改善患者昏迷情况,同时减少术后并发症。

Objective:To investigate the effect of hematoma removal through lateral fissure approach on coma degree and prognosis of patients with hypertensive basal ganglia intracerebral hemorrhage.Method:A total of 128 patients with hypertensive basal ganglia intracerebral hemorrhage who treated in Longyan People's Hospital from August 2020 to August 2022 were selected as subjects and randomly divided into the lateral fissure group and the temporal cortex group,64 cases in each group.Two groups were treated with hematoma removal,the temporal cortex group was operated through the temporal cortex approach,and the lateral fissure group was operated through the lateral fissure approach.The perioperative indexes(operation time,operation bleeding,hospitalization time,hematoma clearance rate)between two groups were compared,the scores of coma degree[Glasgow coma scale(GCS)]between two groups before operation,3 d after operation and 1 week after operation were compared,the incidence of complications(pulmonary infection,cerebral hernia,intracranial rebleeding,epilepsy)in two groups within 1 month after operation were observed,the prognosis of two groups at 3 months after operation[Glasgow outcome scale(GOS)]were compared.Result:The operation time and hospital stay in the lateral fissure group were significantly shorter than those in the temporal cortex group,and the hematoma clearance rate was significantly higher than that in the temporal cortex group,operation bleeding time was less than that in the temporal cortex group,the differences were statistically significant(P<0.05).At 3 d and 1 week after operation,the GCS scores in two groups were significantly higher than those before operation,and the scores in the lateral fissure group were higher than those in the temporal cortex group,the differences were statistically significant(P<0.05).Within 1 month after operation,the incidence of complications in the lateral fissure group were significantly lower than those in the temporal cortex group,the differences were statistically significant(P<0.05).The GOS score in the lateral fissure group at 3 months after operation was significantly better than that in the temporal cortex group,the difference was statistically significant(P<0.05).Conclusion:The treatment of hypertensive basal ganglia intracerebral hemorrhage by hematoma removal through lateral fissure approach has a significant effect,which can improve the coma of patients and reduce postoperative complications.