立体定向辅助下神经内镜与显微镜血肿清除术治疗老年高血压脑出血患者的效果比较

Comparison of effects of stereotactic-assisted neuroendoscopic and microscopic hematoma removal in treatment of elderly patients with hypertensive cerebral hemorrhage

目的:比较立体定向辅助下神经内镜与显微镜血肿清除术治疗老年高血压脑出血(HICH)患者的效果。方法:回顾性分析2019年1月至2023年12月该院收治的80例老年HICH患者的临床资料,根据治疗方法不同将其分为观察组和对照组各40例。观察组采用立体定向辅助下神经内镜血肿清除术治疗,对照组采用立体定向辅助下显微镜血肿清除术治疗,比较两组围术期指标(血肿清除率、血肿清除时间、术中出血量)水平,手术前后血清学指标[神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)]水平、神经功能缺损[美国国立卫生研究院卒中量表(NIHSS)]评分,术后3个月预后情况[格拉斯哥预后评分(GOS)],以及术后3个月并发症发生率。结果:观察组血肿清除率高于对照组,血肿清除时间短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05);术后7 d,两组NSE、GFAP水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);术后7 d、1个月,两组NIHSS评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组预后情况优于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:立体定向辅助下神经内镜血肿清除术治疗老年HICH患者可改善围术期指标水平和预后,降低血清学指标水平和NIHSS评分,效果优于立体定向辅助下显微镜血肿清除术治疗。

Objective:To compare effects of stereotactic-assisted neuroendoscopic and microscopic hematoma removal in treatment of elderly patients with hypertensive intracerebral hemorrhage(HICH).Methods:The clinical data of 80 elderly patients with HICH admitted to the hospital from January 2019 to December 2023 were retrospectively analyzed.According to different treatment methods,they were divided into observation group and control group,40 cases in each group.The observation group was treated with stereotactic-assisted neuroendoscopic hematoma removal,while the control group was treated with stereotactic-assisted microscopic hematoma removal.The levels of perioperative indexes(hematoma clearance rate,hematoma clearance time,intraoperative blood loss)and serological indexes[neuron specific enolase(NSE),glialfibrillary acidic protein(GFAP)]before and after the surgery,the neurological deficit[National Institutes of Health stroke scale(NIHSS)]score,the prognosis 3 months after the surgery[Glasgow outcome scale(GOS)],and the incidence of complications 3 months after the surgery were compared between the two groups.Results:The hematoma clearance rate of the observation group was higher than that of the control group,the hematoma clearance time was shorter than that of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).Seven days after the surgery,the levels of NSE and GFAP in the two groups were lower than those before the surgery,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Seven days and 1 month after the surgery,the NIHSS scores of the two groups were lower than those before the surgery,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The prognosis of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Stereotactic-assisted neuroendoscopic hematoma removal in the treatment of the elderly patients with HICH can improve the perioperative index levels and the prognosis,and reduce the serological index levels and the NIHSS scores.Moreover,it is superior to stereotactic-assisted microscopic hematoma removal.