内镜辅助鞘在高血压脑出血脑内血肿清除术中的应用

Endoscopy Assisted Sheath in the Application of Hypertension Cerebral Hemorrhage Brain Hematoma Removal

目的分析内镜辅助鞘在高血压脑出血(HICH)脑内血肿清除术中的应用。方法选择89例高血压脑出血患者进行研究,根据脑内血肿清除术中是否采用新型可调式神经内镜辅助鞘进行分组,分为有鞘组(n=47)、无鞘组(n=42),比较两组手术情况、临床指标情况、并发症情况及预后发展。结果有鞘组手术时间、术中出血量小于无鞘组,其血肿清除率明显高于无鞘组(P<0.05);与术前比较,两组术后器官功能衰竭评分(SOFA)、急性生理学及慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)、美国国立卫生研究院卒中量表(NIHSS)评分明显降低,且有鞘组各项评分均低于无鞘组(P<0.05);有鞘组颅内感染、癫痫、肺部感染、应激性溃疡发生率明显低于无鞘组(P<0.05);有鞘组预后Ⅱ-V级患者分别有3、9、21、14例,无鞘组预后Ⅱ-V级患者分别有11、15、11、5例,两组预后比较差异具有统计学意义(P<0.05)。结论新型可调式神经内镜辅助鞘在HICH脑内血肿清除术治疗中的临床实用价值较高,可扩大临床应用范围,提高临床手术治疗效率。

Objective Analysis of endoscope assisted sheath in hypertensive intracerebral hemorrhage(HICH)the application of brain hematoma removal.Methods A study was conducted on 89 patients with hypertensive intracerebral hemorrhage.The patients were divided into two groups based on whether a new adjustable neuroendoscope-assisted sheath was used during the hematoma clearance surgery:the sheath group(n=47)and the non-sheath group(n=42).The study aimed to compare the surgical conditions,clinical indicators,complications,and prognosis of the two groups.Results The surgical time and intraoperative blood loss of the sheath group were less than those of the non-sheath group,and the hematoma clearance rate was significantly higher than that of the non-sheath group(P<0.05).Compared with before the surgery,the sepsis organ function failure score(SOFA),the Acute Physiology and Chronic Health EvaluationⅡ(APACHE-Ⅱ),and the National Institutes of Health Stroke Scale(NIHSS)score of both groups significantly decreased after the surgery,and the scores in the sheath group were lower than those in the non-sheath group(P<0.05).The incidence of intracranial infection,epilepsy,pulmonary infection,and stress ulcers in the sheath group was significantly lower than that in the non-sheath group(P<0.05).The prognoses of patients in the sheath group with gradesⅡ-V were 3,9,21,and 14,respectively,while those in the non-sheath group were 11,15,11,and 5,respectively.The difference between the two groups in prognosis was statistically significant(P<0.05).Conclusion The clinical practical value of the new adjustable neuroendoscopic-assisted sheath in the treatment of HICH intracerebral hematoma clearance surgery is high,which can expand the clinical application range and improve the clinical surgical treatment efficiency.