颅内血肿穿刺引流与开颅血肿清除骨瓣治疗高血压脑出血患者对比研究

A Comparative Study of Puncture Drainage of Intracranial Hematoma and Removal of Bone Flap From Craniotomy Hematoma in the Treatment of Hypertensive Cerebral Hemorrhage

目的:对比颅内血肿穿刺引流与开颅血肿清除骨瓣治疗高血压脑出血(HCH)患者的效果。方法:回顾性收集2021年9月—2023年9月厦门市海沧医院收治的62例HCH患者作为研究对象,按手术方案不同分A组和B组,每组各31例。A组接受颅内血肿穿刺引流治疗,B组接受开颅血肿清除骨瓣治疗。对比两组围手术期指标、手术前后美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表问卷(mRS)评分、应激反应[丙二醛(MDA)、P物质(SP)、超氧化物歧化酶(SOD)、C反应蛋白(CRP)水平、并发症发生率]。结果:A组手术时间、住院时间、下床时间相较于B组更短,术中失血量相较于B组更低,差异有统计学意义(P<0.05);A组术后3个月NIHSS、mRS评分及治疗期间并发症发生率相较于B组更低,差异有统计学意义(P<0.05);术后3 d,A组血清MDA、SP、CRP水平相较于B组更低,血清SOD水平相较于B组更高,差异有统计学意义(P<0.05)。结论:与开颅血肿清除骨瓣治疗HCH患者相比,经颅内血肿穿刺引流治疗可进一步优化围术期指标,降低对神经功能造成的损害,减少并发症,促进神经功能恢复,且对机体产生的应激反应更轻微,更有助于提升预后。

Objective:To compare the effect of puncture drainage and removal of bone flap from intracranial hematoma in the treatment of hypertensive cerebral hemorrhage(HCH).Method:The data of 62 patients with HCH from Xiamen Haicang Hospital from September 2021 to September 2023 were retrospectively collected as the study objects,and were divided into group A and group B according to different surgical protocols,with 31 cases in each group.The patients of group A received puncture and drainage treatment for intracranial hematoma,and the patients of group B received bone flap treatment for craniotomy hematoma.Perioperative indexes,National Institutes of Health Stroke Scale(NIHSS),modified Rankin Scale questionnaire(mRS)scores,stress response[malondialdehyde(MDA),substance P(SP),superoxide dismutase(SOD)],C-reactive protein(CRP)levels before and after surgery,and incidence of complications were compared between the two groups.Result:The operation time,hospitalization time and getting out of bed time in group A were shorter than those in group B,and the intraoperative blood loss was lower than those in group B,and the difference was statistically significant(P<0.05).The score of NIHSS and mRS 3 months after operation and the incidence of complications during treatment in roup A were lower than those in group B,and the difference was statistically significant(P<0.05).The serum MDA,SP and CRP levels in group A were lower than those in group B,and the serum SOD level was higher than those in group B,and the difference was statistically significant(P<0.05).Conclusion:Compared with the treatment of HCH patients with craniotomy hematoma removal of bone flap,intracranial hematoma puncture drainage can further optimize perioperative indicators,reduce the damage to nerve function,reduce complications,promote the recovery of nerve function,and produce less stress response to the body,which is more conducive to improving the prognosis.