颞部小骨窗血肿清除术治疗高血压基底节区脑出血疗效观察

Efficacy of temporal small bone window hematoma removal in the treatment of hypertensive basal ganglia hemorrhage

目的 观察颞部小骨窗血肿清除术治疗高血压基底节区脑出血(HBGH)的临床疗效及术后并发症情况。方法 收集2017年1月至2022年6月在安康市中心医院接受手术治疗的102例高血压基底节区脑出血(HBGH)患者的临床资料,按照手术方式分为对照组45例(采用传统额颞大骨瓣开颅血肿清除术)和观察组57例(采用颞部小骨窗血肿清除术)。比较两组患者的手术指标、临床疗效、神经功能损伤程度、术后并发症以及术后生活质量。结果 观察组患者的手术时间、首次睁眼时间分别为(131.72±16.53) min、(6.25±1.76) h,明显短于对照组的(154.65±20.16) min、(7.14±1.83) h,差异均具有统计学意义(P<0.05),但观察组和对照组患者术后24 h内的血肿清除率分别为(90.73±14.35)%、(85.24±15.72)%,差异无统计学意义(P>0.05);观察组患者的治疗总有效率为61.40%,明显高于对照组的35.56%,差异具有统计学意义(P<0.05);观察组和对照组患者术后1个月内的美国国立卫生院卒中量表(NIHSS)得分分别为(28.12±3.53)分、(28.34±3.46)分,差异无统计学意义(P>0.05),而3个月后观察组患者的NIHSS得分为(26.47±3.58)分,明显低于对照组的(27.91±3.47)分,差异具有统计学意义(P<0.05);观察组患者术后3个月内的总并发症发生率为15.79%,明显低于对照组的33.33%,差异具有统计学意义(P<0.05);术后1个月,两组患者的脑卒中专用生活质量量表(SS-QOL)各维度评分比较差异均无统计学意义(P>0.05),而术后3个月,观察组患者的SS-QOL各维度评分明显高于对照组,差异均有统计学意义(P<0.05)。结论 采取颞部小骨窗血肿清除术治疗HBGH患者临床疗效良好,且能减轻患者神经功能损伤程度,降低术后并发症发生率,改善患者生活质量。

Objective To observe the clinical efficacy and postoperative complications of temporal small bone window hematoma removal in the treatment of hypertensive basal ganglia hemorrhage(HBGH).Methods The clinical data of 102 patients with HBGH who underwent surgical treatment in Ankang Central Hospital from January 2017 to June 2022 were collected,and the patients were divided into control group(n=45,traditional frontotemporal large bone flap craniotomy hematoma removal)and observation group(n=57,temporal small bone window hematoma removal)by means of surgical methods.The surgical indicators,clinical efficacy,degree of neurological impairment,postoperative complications,and postoperative quality of life were compared between the two groups.Results The surgical time and first eye opening time were(131.72±16.53)min and(6.25±1.76)h in the observation group,significantly shorter than(154.65±20.16)min and(7.14±1.83)h in the control group(P<0.05);there was no statistically significant difference in the hematoma clearance rate within 24 h after surgery between the observation group and the control group:(90.73±14.35)%vs(85.24±15.72)%,P>0.05.The total effective rate of treatment in the observation group was significantly higher than that in the control group(61.40%vs 35.56%,P<0.05).There was no statistically significant difference in the score of National Institutes of Health Stroke Scale(NIHSS)between the observation group and the control group within 1 month after surgery:(28.12±3.53)points vs(28.34±3.46)points,P>0.05.The NIHSS score in observation group after 3 months was(26.47±3.58)points,which was significantly lower than(27.91±3.47)points in the control group(P<0.05).The total incidence rate of complications within 3 months after surgery was 15.79%in the observation group,which was significantly lower than 33.33%in the control group(P<0.05).At 1 month after surgery,there were no differences in the scores of dimensions of Stroke Specific Quality of Life Scale(SS-QOL)between the two groups(P>0.05).At 3 months after surgery,the scores of SS-QOL in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Temporal small bone window hematoma removal has a good clinical efficacy in the treatment of patients with HBGH,and it can relieve the degree of neurological impairment,reduce the incidence rates of postoperative complications,and improve the quality of life of patients.