微创定向软通道手术治疗高血压脑出血的临床效果

Clinical efficacy of minimally invasive directional soft channel surgery in the treatment of patients with hypertensive intracerebral hemorrhage

目的观察微创定向软通道手术治疗高血压脑出血患者的临床疗效。方法将58例高血压脑出血患者随机分为微创组(30例)和开颅组(28例);其中,微创组行微创定向软通道手术治疗,开颅组行开颅血肿清除术治疗。比较两组手术时间、术中出血量、术后48h颅内压、术后72 h残余血肿量和血肿清除率、住院时间、术前及术后7dGCS评分、治疗总有效率、术前及术后3个月Barthel指数,记录术后并发症发生情况。结果两组术后7d GCS评分和术后3个月Barthel指数评分均高于术前(P<0.05或P<0.01)。与开颅组相比,微创组手术时间、术中出血量、住院时间减少,术后72h残余血肿量、术后7dGCS评分、治疗总有效率和术后3个月Barthel指数评分增加,术后72h血肿清除率以及术后癫痫、脑积水和肺部感染发生率降低(P<0.05或P<0.01);两组术后48h颅内压比较无统计学差异(P>0.05)。结论微创定向软通道手术治疗高血压脑出血具有简单易行、创伤较小、安全性较高、恢复较快和临床疗效较好等优势。

Objective To observe the clinical efficacy of minimally invasive directional soft channel surgery in the treatment of the patients with hypertensive intracerebral hemorrhage.Methods Fifty-eight patients with hypertensive intracerebral hemorrhage were randomly divided into two groups of A(30 cases)and B(28 cases).The patients in group A accepted minimally invasive directional soft channel surgery,while those in group B received craniotomy hematoma removal.The operation time,intraoperative blood loss,intracranial pressure in 48 hours after operation,residual hematoma volume and clearance rate of hematoma at 72 hours after operation,hospital stay,GCS score before and at 7 days after operation,total effective rate of treatment,Barthel index before and in 3 months after operation and incidence of postoperative complications were compared between the two groups.Results The GCS score at 7 days after operation and Barthel index in 3 months after operation were higher than those before operation in both groups(P<0.05 or P<0.01).Compared with group B,the operation time,intraoperative blood loss and hospital stay were decreased,the residual hematoma volume at 72 hours after operation,GCS score at 7 days after operation,total effective rate of treatment and Barthel index in 3 months after operation were increased,and the clearance rate of hematoma at 72 hours after operation and incidences of postoperative epilepsy,hydrocephalus and pulmonary infection were reduced in group A(P<0.05 or P<0.01).There was no statistical difference in the intracranial pressure at 48 hours after operation between groups of A and B(P>0.05).Conclusion The minimally invasive directional soft channel surgery in the treatment of the patients with hypertensive intracerebral hemorrhage has the advantages of simpler and easier operation,less trauma,higher safety,quicker recovery and better clinical efficacy.