小骨瓣经侧颞入路高血压脑出血手术治疗的效果观察

Effect Observation of Small Bone Flap via Lateral Temporal Approach in Surgical Treatment of Hypertensive Intracerebral Hemorrhage

目的观察高血压脑出血治疗中小骨瓣经侧颞入路手术的效果。方法回顾性选取2020年2月-2022年2月本院高血压脑出血患者100例,依据手术方法分为小骨瓣经侧颞入路手术组(小骨瓣手术组)、传统开颅手术组两组,各50例。统计分析两组围术期指标、血肿清除情况、血压、颅内压、神经功能、昏迷程度、心理状态、生活质量、术后并发症发生情况、预后。结果小骨瓣手术组患者的术中出血量少于传统开颅手术组(P<0.05),手术时间、住院时间均短于传统开颅手术组(P<0.05),血肿清除率低于传统开颅手术组(P<0.05)。小骨瓣手术组患者的舒张压、收缩压、颅内压、焦虑评分、抑郁评分均低于传统开颅手术组(P<0.05),MESSS评分、GCS评分、GQOLI-74评分均高于传统开颅手术组(P<0.05)。小骨瓣手术组患者的术后并发症发生率低于传统开颅手术组(χ^(2)=13.562,P<0.05)。小骨瓣手术组患者的预后Ⅰ级、Ⅱ级比率均高于传统开颅手术组,Ⅴ级比率低于传统开颅手术组,但两组患者的预后Ⅲ级、Ⅳ级比率之间的差异均不显著(Z=1.981,P<0.05)。结论高血压脑出血治疗中小骨瓣经侧颞入路手术的效果较传统开颅手术好。

Objective To observe effect of small and medium-sized bone flap surgery via lateral temporal approach for hypertensive intracerebral hemorrhage.Methods The paper reviewed and chose 100 patients with hypertensive intracerebral hemorrhage in our hospital from February 2020 to February 2022,and divided them into two groups according to surgical method:small bone flap surgery via lateral temporal approach group(small bone flap surgery group)and traditional craniotomy surgery group,with 50 cases in each group,(P<0.05).Statistical analysis was carried out between two groups on perioperative indicators,including hematoma clearance,blood pressure,intracranial pressure,neurological function,coma degree,psychological status,life quality,postoperative complications and prognosis.Results Intraoperative bleeding volume of patients in small bone flap surgery group was lower than traditional craniotomy group(P<0.05),surgical time and length of stay was shorter than traditional craniotomy group(P<0.05).Hematoma clearance rate was lower than traditional craniotomy group(P<0.05).Diastolic blood pressure,systolic blood pressure,intracranial pressure,anxiety scores and depression scores of patients in small bone flap surgery group were lower than traditional craniotomy group(P<0.05),while MESSS scores,GCS scores and GQOLI-74 scores were higher than traditional craniotomy group(P<0.05).Incidence of postoperative complications in small bone flap surgery group was 6.00%(3/50),lower than 36.00%(18/50)in traditional craniotomy group,(χ^(2)=13.562,P<0.05).Prognosis in small bone flap surgery group showed higher levels of grade I and gradeⅡthan lower levels of grade V in traditional craniotomy group,(P<0.05).However,there was no significant difference in prognosis of gradeⅢand gradeⅣbetween two groups(Z=1.981,P<0.05).Conclusion Small and medium-sized bone flap via lateral temporal approach can achieve better effect in treatment of hypertensive intracerebral hemorrhage with than traditional craniotomy.