神经内镜与小骨窗血肿清除术治疗基底节脑出血的有效性及安全性对比

Comparison of Efficacy and Safety Between Neuroendoscopy and Small Window Craniotomy for Hematoma Evacuation for the Treatment of Basal Ganglia Cerebral Hemorrhage

目的对比神经内镜、小骨窗血肿清除术治疗基底节脑出血患者的效果。方法选取2020年9月—2023年9月莒县人民医院收治的84例基底节脑出血患者为研究对象,按随机数字表法将其分为对照组及观察组,每组42例。对照组行小骨窗血肿清除术,观察组行神经内镜血肿清除术。对比两组患者的手术相关指标、神经功能、神经营养因子、生活质量及并发症发生情况。结果观察组的术中出血量为(175.31±18.72)mL,少于对照组的(246.75±23.59)mL,手术时间、住院时间分别为(146.83±9.22)min、(10.34±1.97)d,均短于对照组的(189.76±11.46)min、(13.45±2.36)d,组间差异有统计学意义(P<0.05)。术后1个月,观察组的美国国立卫生研究院卒中量表评分为(11.25±1.21)分,低于对照组的(15.31±1.59)分,脑源性神经营养因子、胰岛素样生长因子-1、神经生长因子水平分别为(4.96±1.22)ng/mL、(114.37±9.25)μg/L、(147.25±15.31)pg/mL,均高于对照组的(4.30±0.95)ng/mL、(105.29±7.31)μg/L、(134.51±13.95)pg/mL,组间差异有统计学意义(P<0.05);观察组的生活质量综合评定问卷中躯体功能、心理功能、社会功能、物质生活状态评分分别为(78.95±5.31)分、(79.96±5.22)分、(79.84±5.39)分、(80.31±5.42)分,均高于对照组的(69.83±4.46)分、(71.35±4.19)分、(70.58±4.23)分、(72.59±4.59)分,组间差异有统计学意义(P<0.05)。观察组的并发症发生率为4.76%,低于对照组的21.43%,差异有统计学意义(P<0.05)。结论神经内镜血肿清除术具有损伤小、并发症少等优点,可改善基底节脑出血患者神经功能,提升其神经营养因子水平,改善其生活质量。

Objective To compare the effect of neuroendoscopy and small window craniotomy for hematoma evacuation in the treatment of basilar ganglia cerebral hemorrhage.Methods Eighty four patients with basal ganglia cerebral hemorrhage admitted to Ju County People's Hospital from September 2020 to September 2023 were selected as the study objects,and were divided into a control group and an observation group according to random number table method,with 42 cases in each group.The control group underwent small window craniotomy for hematoma evacuation,and the observation group underwent neuroendoscopic hematoma removal.The surgical indexes,neurological function,neurotrophic factors,quality of life and complications were compared between the two groups.Results The intraoperative blood loss in the observation group was(175.31±18.72)mL,which was less than(246.75±23.59)mL in the control group,the operation time and hospital stay were(146.83±9.22)min and(10.34±1.97)d,respectively,which were shorter than(189.76±11.46)min and(13.45±2.36)d in the control group,and the differences between the groups were statistically significant(P<0.05).After 1 month of surgery,the National Institute of Health Stroke Scale score of the observation group was(11.25±1.21)points,which was lower than(15.31±1.59)points of the control group,while the levels of brain-derived neurotrophic factor,insulin-like growth factor-1 and nerve growth factor were(4.96±1.22)ng/mL,(114.37±9.25)μg/L and(147.25±15.31)pg/mL,respectively,which were higher than(4.30±0.95)ng/mL,(105.29±7.31)μg/L and(134.51±13.95)pg/mL of the control group,and the differences between the groups were statistically significant(P<0.05);the scores of physical function,psychological function,social function and material life status in the generic quality of life inventory-74 in the observation group were(78.95±5.31)points,(79.96±5.22)points,(79.84±5.39)points and(80.31±5.42)points,respectively,which were higher than(69.83±4.46)points,(71.35±4.19)points,(70.58±4.23)points and(72.59±4.59)points of the control group,and the differences between the groups were statistically significant(P<0.05).The incidence of complications in the observation group was 4.76%,which was lower than 21.43%in the control group,and the difference was statistically significant(P<0.05).Conclusion Neuroendoscopic hematoma removal has the advantages of less injury and complications,which can improve the nerve function,increase the level of neurotrophic factor and improve the quality of life of patients with basal ganglia cerebral hemorrhage.