中等量脑叶出血保守治疗与内镜手术治疗的预后比较

Comparison study of prognosis between conservative treatment and endoscopic surgery for moderate lobar cerebral hemorrhage

目的 观察并比较中等量脑叶脑出血行保守治疗与内镜辅助下手术治疗的中远期预后情况,以供临床参考。方法 根据治疗方式,将205例中等量脑叶脑出血患者分为保守治疗组(113例)和内镜手术组(92例)。统计两组患者治疗1个月内的住院时间、脑水肿持续时间、脑水肿最大体积来评估短期预后情况,采用日常生活活动(activity of daily living,ADL)评分和简易智力状况检查法(mini-mentalstateexamination,MMSE)评估患者治疗3个月、6个月后的预后情况。结果 保守治疗组和内镜手术组的住院时间、脑水肿持续时间、脑水肿最大体积,差异有统计学意义(P<0.05)。治疗1个月内,保守治疗组发生肺部感染29例、水电解质紊乱73例、脑梗死25例、下肢静脉血栓43例,内镜手术组分别发生11例、70例、10例、20例,2组水电解质紊乱的发生情况差异无统计学意义(χ~2=3.17,P=0.075),肺部感染、脑梗死、下肢静脉血栓的发生情况,差异有统计学意义(均P<0.05)。治疗后1、3、6个月,内镜手术组的GCS评分均高于保守治疗组;治疗后3、6个月,内镜手术组的ADL评分、MMSE评分均高于保守治疗组;差异均有统计学意义(P<0.05)。结论 内镜手术治疗中等量脑叶脑出血,患者的长期独立生活能力和智力水平均优于保守治疗。

Objective To observe and compare the mid-to long-term prognosis of moderate lobar cerebral hemorrhage treated with conservative treatment and endoscopic-assisted surgery,providing clinical reference.Methods A total of 205 patients with moderate lobar cerebral hemorrhage were divided into a conservative treatment group(113 cases) and an endoscopic surgery group(92 cases) according to their treatment methods.The length of hospital stay within 1 month,duration of cerebral edema,and maximum volume of cerebral edema were collected and compared between the two groups to evaluate short-term prognosis.The activity of daily living(ADL) score and mini-mental state examination(MMSE) were used to evaluate the prognosis of patients at 3 and 6 months after treatment.Results There were statistically significant differences in hospital stay,duration of brain edema,and maximum volume of brain edema between the conservative treatment group and the endoscopic surgery group(P<0.05).Within 1 month of treatment,the conservative treatment group had 29 cases of pulmonary infection,73 cases of electrolyte imbalance,25 cases of cerebral infarction,and 43 cases of lower extremity venous thrombosis,while the endoscopic surgery group had 11 cases,70 cases,10 cases,and 20 cases,respectively.There was no statistically significant difference in the occurrence of electrolyte imbalance between the two groups(χ~2=3.17,P=0.075),but the occurrence of pulmonary infection,cerebral infarction,and lower extremity venous thrombosis showed statistical significance(all P<0.05).At 1,3,and 6 months after treatment,the endoscopic surgery group had higher GCS scores compared to the conservative treatment group.At 3 and 6 months after treatment,the endoscopic surgery group had higher ADL scores and MMSE scores compared to the conservative treatment group.The differences were statistically significant(P<0.05).Conclusions Endoscopic surgery for moderate lobar cerebral hemorrhage has been found to result in better long-term independent living ability and cognitive function compared to conservative treatment.