神经内镜血肿清除术治疗高血压脑出血的效果研究

Study on the effect of endoscopic hematoma evacuation in patients with hypertensive intracerebral hemorrhage

目的探讨神经内镜血肿清除术治疗高血压脑出血(HICH)患者的临床疗效。方法60例高血压脑出血患者,采用随机数字表法分为观察组与对照组,各30例。对照组采用传统骨瓣开颅手术治疗,观察组采用神经内镜血肿清除术治疗。比较两组患者手术时间、术中出血量、引流量、神志清醒时间、下床活动时间、美国国立卫生研究院卒中量表(NIHSS)评分、并发症发生情况、治疗效果及生活质量。结果观察组患者手术时间(1.57±0.23)h、神志清醒时间(3.27±0.67)d、下床活动时间(6.28±1.01)d均短于对照组的(2.89±0.25)h、(5.89±0.98)d、(11.23±1.39)d,术中出血量(132.4±21.8)ml、引流量(109.2±12.5)ml均少于对照组的(292.3±45.2)、(198.4±14.8)ml,差异具有统计意义(P<0.05)。术后1、2、4周,观察组NIHSS评分分别为(27.65±0.32)、(23.15±0.64)、(20.28±0.17)分,均低于对照组的(28.84±1.73)、(25.11±1.26)、(21.17±1.56)分,差异有统计学意义(P<0.05)。观察组并发症发生率6.67%低于对照组的26.67%,差异有统计学意义(P<0.05)。观察组治疗总有效率93.33%明显高于对照组的73.33%,差异有统计学意义(P<0.05)。术后4周,观察组身体功能评分(75.17±1.98)分、躯体疼痛评分(78.36±2.51)分、社会功能评分(80.34±2.66)分、心理卫生评分(73.89±6.11)分均高于对照组的(73.08±0.45)、(76.66±1.24)、(78.13±1.57)、(70.43±5.04)分,差异有统计学意义(P<0.05)。结论神经内镜血肿清除术治疗高血压脑出血可以降低手术风险,改善神经功能,提高治疗效果,预后较好,值得临床推广。

Objective To discuss the clinical efficacy of endoscopic hematoma evacuation in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 60 patients with hypertensive intracerebral hemorrhage were divided into observation group and control group according to random numerical table,with 30 cases in each group.The control group was treated with conventional craniotomy,and the observation group was treated with endoscopic hematoma evacuation.Both groups were compared in terms of operative time,intraoperative blood loss,drainage volume,waking time,ambulation time,National Institutes of Health Stroke Scale(NIHSS)score,incidence of complications,therapeutic effect and quality of life.Results The the observation group had operative time of(1.57±0.23)h,waking time of(3.27±0.67)d and ambulation time of(6.28±1.01)d,which were shorter than those of(2.89±0.25)h,(5.89±0.98)d and(11.23±1.39)d in the control group;the intraoperative blood loss of(132.4±21.8)ml and drainage volume of(109.2±12.5)ml in the observation group were lower than those of(292.3±45.2)and(198.4±14.8)ml in the control group;the difference were statistically significant(P<0.05).At 1,2 and 4 weeks after surgery,the NIHSS scores of the observation group were(27.65±0.32),(23.15±0.64)and(20.28±0.17)points,which were lower than those of(28.84±1.73),(25.11±1.26)and(21.17±1.56)points of the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 6.67%,which was lower than that of 26.67%in the control group,and the difference was statistically significant(P<0.05).The total effective rate of 93.33%in the observation group was significantly higher than that of 73.33%in the control group,and the difference was statistically significant(P<0.05).At 4 weeks after surgery,the observation group had physical function score of(75.17±1.98)points,bodily pain score of(78.36±2.51)points,social function score of(80.34±2.66)points,and mental health score of(73.89±6.11)points,which were higher than those of(73.08±0.45),(76.66±1.24),(78.13±1.57),and(70.43±5.04)points in the control group,and the difference were statistically significant(P<0.05).Conclusion Endoscopic hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage can reduce the risk of surgery,improve neurological function and therapeutic effect,and has a good prognosis,which is worthy of promotion and application in clinical treatment.