神经内镜下血肿清除术与小骨窗血肿清除术在基底节脑出血治疗中的应用

Application of Neuroendoscopic Hematoma Removal and Small Bone Window Hematoma Removal in the Treatment of Basal Ganglia Cerebral Hemorrhage

目的探讨对基底节脑出血患者采用神经内镜或小骨窗血肿清除术治疗的效果差异。方法选取2018年1月—2023年4月无锡市锡山人民医院收治的基底节脑出血患者68例,随机数表法分为两组。对照组(n=34)予小骨窗血肿清除术,观察组(n=34)予神经内镜下血肿清除术治疗,比较两组患者手术及预后指标,检测肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)与白介素-6(interleukin-6,IL-6),评估炎症反应,比较并发症总发生率。结果观察组手术时间为(97.05±11.49)min,住院时间为(7.52±1.21)d,短于对照组;观察组出血量为(45.60±7.12)mL,少于对照组;观察组血肿清除率为(89.15±10.27)%,高于对照组;治疗后观察组临床神经功能缺损程度评分为(19.51±3.15)分,低于对照组,差异有统计学意义(t=7.507、27.522、8.208、4.857、6.144,P<0.05)。治疗后观察组CRP(12.76±3.10)mg/L、TNF-α(17.56±2.84)μg/L、IL-6(25.86±4.76)pg/mL,均小于对照组,差异有统计学意义(t=9.046、6.297、14.281,P<0.05)。观察组并发症发生率5.88%低于对照组23.53%差异有统计学意义(χ^(2)=4.221,P<0.05)。结论对基底节脑出血者予神经内镜下血肿清除术治疗操作简单且对患者损伤小,血肿清除率高,患者恢复良好,可减轻炎症反应,降低并发症风险。

Objective To investigate the effect of neuroendoscopic or removal of small bone window hematoma in patients with basal ganglia cerebral hemorrhage.Methods A total of sixty-eight patients with basal ganglia cerebral hemorrhage admitted to Wuxi Xishan People's Hospital from January 2018 to April 2023 were selected and grouped in two groups by random number table method.The control group(n=34)was treated with small bone window hematoma,and the observation group(n=34)was treated with neuroendoscopic hematoma.The surgical and prognostic indexes of the two groups patients were compared,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)were detected to evaluate the inflammatory response,and the total complication rate was compared.Results The operation time and hospitalization time of the observation group were(97.05±11.49)min and(7.52±1.21)d,respectively,which were shorter than those of the control group;blood loss of the observation group was(45.60±7.12)mL,which was less than that of the control group;the clearance rate of hematoma of the observation group was(89.15±10.27)%,which was higher than that of control group;NFDS score of the observation group after treatment(19.51±3.15)points was lower than that of control group,and the difference was statistically significant(t=7.507,27.522,8.208,4.857,6.144,P<0.05).After treatment,CRP(12.76±3.10)mg/L,TNF-α(17.56±2.84)μg/L and IL-6(25.86±4.76)pg/mL in observation group were lower than those in control group,and the difference was statistically significant(t=9.046,6.297,14.281,P<0.05).The complication rate in the observation group was 5.88%lower than that of the control group 23.53%,and the difference was statistically significant(χ^(2)=4.221,P<0.05).Conclusion For patients with basal ganglia hemorrhage,the operation of neuroendoscopic hematoma removal is simple and has little damage to the patients,high hematoma clearance rate,and good recovery of the patients,which can reduce inflammation and reduce the risk of complications.