Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.

Effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage

Objective:To study the effect of minimally invasive intracranial hematoma drainage on inflammatory factors, serum ferritin and serum P substance in patients with hypertensive cerebral hemorrhage.Methods:92 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: minimally invasive group (51 cases) and routine group (41 cases). Minimally invasive intracranial hematoma drainage was performed on the minimally invasive group. Bone flap decompression or small bone window craniotomy were used in the routine group. Tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and serum protein (SF), serum substance P (SP) in the 2 groups were detected before treatment and 2 weeks after treatment.Results: The comparison of TNF-α, IL-6, hs-CRP, SP, and SF in the two groups before treatment was not statistically significant (P>0.05). TNF-α, IL-6, hs-CRP and SF in both groups after treatment significantly decreased, compared with that before treatment (P<0.01,P<0.05). TNF-α, IL-6, and SF in minimally invasive group decreased more significantly than that in routine group (P<0.01);The comparison of SP in the two groups after treatment significantly increased compared with that before treatment (P<0.01,P<0.05). SP in minimally invasive group increased more significantly than that in routine group (P<0.05).Conclusions:Compared with bone flap decompression or small bone window craniotomy, minimally invasive intracranial hematoma drainage can inhibit inflammatory reaction, reduce the degree of nerve damage and alleviate clinical symptoms more effectively.

Effect of urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle on the blood sugar and serum CRP in patients with hypertensive cerebral hemorrhage

Objective:To observe the clinical efficacy of urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle in the treatment of hypertensive cerebral hemorrhage and the effect on blood sugar and serum CRP.Methods:A total of 84 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group (n=53) and the conservative group (n=31) according to different treatment protocols. The patients in the two groups were given routine drug treatments. The patients in the observation group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. The blood sugar and serum CRP levels before and after treatment in the two groups were compared. CT was performed to reexamine the cerebral hematoma and edema volume.Results: The serum CRP and blood sugar levels 3, 7 and 14 d after treatment in the minimally invasive group were significantly lower than those in the conservative group (P<0.05). The cerebral hematoma and edema volume 1, 3, 7, and 14 d after treatment in the minimally invasive group was significantly lower than that in the conservative group (P<0.05).Conclusions: Urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle in the treatment of hypertensive cerebral hemorrhage can significantly alleviate the brain tissue injury, reduce the systemic inflammatory reaction and blood sugar level, and contribute to the rehabilitation.

Effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function injury and cytokine level in patients with hypertensive cerebral hemorrhagen

Objective:To study the effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function damage and cytokine level in patients with hypertensive cerebral hemorrhage.Methods:A total of 80 patients with hypertensive cerebral hemorrhage treated in our hospital between June 2010 and September 2015 were selected as the research subjects, the treatment methods and test results were reviewed, and then they were divided into the control group (n=45) who accepted minimally invasive evacuation of hematoma alone and the observation group (n=35) who accepted minimally invasive evacuation of hematoma combined with Xingnaojing therapy. Before and after treatment, cerebral blood flow detector was used to detect cerebral blood flow parameters;ELISA method was used to detect serum levels of neurological function indexes and inflammatory cytokines;high performance liquid chromatograph was used to detect serum neurotransmitter levels. Results: Before treatment, the differences in cerebral blood flow parameters, neurological function indexes, inflammatory cytokines and neurotransmitters were not statistically significant between two groups of patients. After treatment, cerebral blood flow parameters Q and V levels of observation group were higher than those of control group while R level was lower than that of control group;serum NSE, NPY, IL-1β, IL-4, IL-6, TNF-α, Glu and Asp contents of observation group were lower than those of control group while BDNF and Gly contents were higher than those of control group.Conclusion: Minimally invasive evacuation of hematoma combined with Xingnaojing therapy can improve the neurological function and regulate the synthesis of inflammatory cytokines and neurotransmitters in patients with hypertension cerebral hemorrhage.

Therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and TCD evaluation

Objective:To explore the therapeutic effect of minimally invasive intracranial hematoma evacuation in the treatment of hypertensive cerebral hemorrhage and the value of dynamic TCD monitoring in predicting the neurological function recovery.Methods: A total of 70 patients with hypertensive cerebral hemorrhage who were admitted in our hospital were included in the study and divided into the minimally invasive group and conservative group with 35 cases in each group according to different treatment protocols. The patients in the two groups were given drug conservative treatments. On this basis, the patients in the minimally invasive group were given urokinase in combined with minimally invasive hematoma puncture with YL-1 type needle. TCD was performed before treatment, 1 d, 5 d, 10 d, and 21 d after treatment. The hematoma and edema volume was calculated. NIHSS was used to evaluate the neurological function recovery.Results: Vs, Vd, and Vm after treatment in the minimally invasive group were significantly elevated, while PI was significantly reduced. Vs, Vd, and Vm after treatment in the conservative group were reduced first and elevated later, while PI was elevated first and reduced later, and reached the lowest/peak 10d after treatment. Vs, Vd, and Vm 5 d, 10 d, and 21 d after treatment in the minimally invasive group were significantly higher than those in the conservative group, while PI was significantly lower than that in the conservative group. The hematoma and edema volume after treatment in the two groups was significantly reduced. The hematoma and edema volume at each timing point was significantly lower than that in the conservative group. NIHSS score after treatment in the minimally invasive group was significantly reduced. NIHSS score in the conservative group was elevated first and reduced later, reached the peak 10d after treatment, and at each timing point was higher than that in the minimally invasive group.Conclusions:The early minimally invasive operation can significantly improve the hematoma adjacent blood flow volume in patients with hypertensive cerebral hemorrhage, and contribute to the neurological function recovery. TCD not only can be applied in the dynamic monitoring of cerebral blood flow volume in patients with hypertensive cerebral hemorrhage, but also has a certain value in evaluating the prognosis of neurological function.

Effect of minimally invasive craniotomy combined with edaravone on cerebral oxygen metabolism, cerebrovascular function and oxidative stress in patients with acute cerebral hemorrhage

Objective:To investigate the effects of minimally invasive craniotomy combined with edaravone on cerebral oxygen metabolism, cerebrovascular function and oxidative stress in patients with acute cerebral hemorrhage.Methods:A total of 100 patients with acute cerebral hemorrhage treated in our hospital from March 2015 to February 2017 were randomly divided into control group and observation group. 50 patients in the control group were treated with minimally invasive craniotomy. On the basis of control group, patients in the observation group were treated with edaravone. Cerebral oxygen metabolism, cerebrovascular function and oxidative stress were measured later in both groups.Results:After treatment, the levels of SOD in both groups increased significantly and MDA levels decreased significantly, and SOD level in the observation group was (97.34±1.95) U/mL, which was significantly higher than the control group, MDA level was (2.77±0.11) mol/L and significantly lower than that of the control group after treatment;After treatment, the levels of ET in both groups were significantly lower than those before treatment, and the levels of CGRP were significantly higher than those before treatment. ET level in observation group was (3.24±0.22) μg/L after treatment, which was significantly lower than that in control group (59.67±0.79) pg/mL, which was significantly higher than the control group;After treatment, the levels of SjvO2, CjvO2 and PbtO2 in both groups were significantly increased compared with before treatment, the levels of Da-jvO2 and CEO2 were significantly lower than the level of before treatment, and the levels of SjvO2, The levels of CjvO2 and PbtO2 were (62.93±1.63)%, (99.31±0.94) mL/L and (28.56±1.55) mmHg, which were significantly higher than the control group. Da-jvO2 and CEO2 levels were (51.31±1.13) mL/L and (30.52±0.43)%, which were significantly lower than the control group.Conclusion: Edaravone combined with minimally invasive craniotomy can effectively reduce the level of oxidative stress, improve endothelial function and cerebral oxygen metabolism, and has reliable curative effect. It is worth further clinical application.

术前血清碱性磷酸酶、骨桥蛋白与基底节区脑出血患者神经内镜清除术预后的关系

目的分析术前血清碱性磷酸酶(ALP)与骨桥蛋白(OPN)与基底节区脑出血患者神经内镜清除术预后的关系,评估其对患者预后的预测价值。方法回顾性采集2019年1月至2023年6月于商丘市第一人民医院完成神经内镜下微创血肿清除术治疗的65例基底节区脑出血患者的资料。记录研究所需实验室指标结果数据,包括术前及术后血清ALP、OPN水平,统计术后1个月患者预后情况,分析脑出血患者术前血清ALP、OPN与预后的关系。结果65例基底节区脑出血患者预后不良14例,占比21.54%。术前及术后,预后不良组患者血清ALP、OPN高于预后良好组(P<0.05)。经过点二列相关性分析,术前血清ALP、OPN与脑出血患者预后不良呈正相关关系(r>0,P<0.05)。绘制受试者工作特征(ROC)曲线,结果显示,术前血清ALP、OPN预测脑出血患者预后不良的曲线下面积(AUC)均>0.70,联合预测的AUC>0.80,联合预测价值更高。结论基底节区脑出血患者神经内镜清除术前ALP、OPN越高,预后不良的可能性越大,术前ALP、OPN可以作为基底节区脑出血患者神经内镜清除术后预后不良的有效预测指标。

微创手术治疗中少量高血压脑出血的临床疗效观察

目的:分析中少量高血压脑出血患者应用微创手术治疗的效果。方法:选取2021年5月—2023年5月太仓市第一人民医院收治的中少量高血压脑出血患者62例为研究对象,按照治疗方式不同分为对照组和观察组,各31例。对照组应用开颅血肿清除术治疗,观察组采用微创手术治疗。观察两组患者血肿清除率、再出血发生率、昏迷情况、神经功能缺损情况、自理能力和日常生活情况。结果:两组患者治疗5 d后,观察组血肿清除率高于对照组,再出血发生率低于对照组,差异有统计学意义(P<0.05)。治疗后1、2、3周,两组患者昏迷、神经功能缺损评分与治疗前比较,差异有统计学意义(P<0.05);且两组治疗后2、3周昏迷评分高于治疗后1周,神经功能缺损评分低于治疗后1周,差异有统计学意义(P<0.05);治疗后3周昏迷评分高于治疗后2周,神经功能缺损评分低于治疗后2周,差异有统计学意义(P<0.05)。观察组患者治疗后1、2、3周昏迷评分高于对照组,神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。随访1年后,观察组自理能力和日常生活能力评分优于对照组,差异有统计学意义(P<0.05)。结论:对中少量高血压脑出血患者中应用微创手术治疗的血肿清除率高,再出血风险低,患者可尽早恢复,并减少神经功能受损,利于患者远期预后康复。

中等量高血压脑出血机器人辅助穿刺微创手术与保守治疗的临床研究

目的:探究中等量高血压脑出血机器人辅助穿刺微创手术与保守治疗比较。方法:选取2021年7月~2022年7月华中科技大学协和深圳医院100例中等量高血压脑出血患者,采用随机数字表法分为参照组(保守治疗)和试验组(机器人辅助穿刺微创手术)各50例,对干预效果进行比较。结果:试验组总有效率94.00%高于参照组72.00%,差异有统计学意义(P<0.05),试验组失血量、手术、血肿清除、脑脊液恢复、置管引流、住院时长均少于参照组,差异有统计学意义(P<0.05),手术后1 min、1 d、3 d试验组的颅内压小于参照组,差异有统计学意义(P<0.05),两组手术前的炎性因子比较,差异无统计学意义(P>0.05),试验组手术后的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白介素-6(IL-6)均小于参照组,差异有统计学意义(P<0.05),研究对象手术前的神经功能缺损(NIHSS)、日常生活能力(ADL)、格拉斯昏迷评分(GCS)、格拉斯哥预后评分(GOS)比较,差异无统计学意义(P>0.05),试验组手术后的NIHSS评分低于参照组,但ADL、GCS、GOS评分高于参照组,差异有统计学意义(P<0.05)。结论:机器人辅助穿刺微创手术能够快速降低患者颅内压,并清除血肿,缩短住院天数,促进炎性反应消失,改善患者神经功能,促进预后。

微创血肿清除术与开颅手术治疗脑出血的临床效果比较

目的对比分析脑出血患者采取微创血肿清除术与开颅手术治疗的效果,并探讨两种手术方式对患者康复情况的影响。方法采用回顾性研究的方式,将2020年4月—2023年4月本院收治的423例脑出血患者作为研究对象,按照手术方式将其分为A组(111例)和B组(312例)。其中,A组患者采取开颅血肿清除术,B组患者采取微创血肿清除术,患者的手术治疗时间均处于限期内。对比分析微创血肿清除术与开颅手术治疗的效果,评价指标为围手术期指标、康复情况、炎症因子。结果B组患者术中出血量少于A组,B组患者手术时间、住院时间均短于A组(P<0.05);手术后,两组患者NHISS评分均降低,GCS评分、ADL评分均升高,且B组患者变化程度大于A组(P<0.05);手术后,两组患者IL-6、hs-CRP、TNF-α水平均下降,且B组各指标水平均低于A组(P<0.05)。结论微创血肿清除术能够缩短患者手术后恢复时间,改善手术指标,并能增强患者神经功能,降低术后炎症反应,有效改善患者的昏迷状况,促进生活能力的提升,具有更高的安全性。

神经内镜微创手术治疗高血压脑出血的效果分析

目的:分析神经内镜微创手术治疗高血压脑出血的效果。方法:选取2020年1月—2022年12月新疆生产建设兵团第一师医院收治的高血压脑出血患者120例作为研究对象,依据双色球法分为观察组与对照组,各60例。对照组采取开颅血肿清除术治疗,观察组采取神经内镜微创手术治疗。比较两组临床疗效。结果:观察组手术时间短于对照组,术中出血量少于对照组,血肿清除率高于对照组,差异有统计学意义(P<0.001)。观察组术后并发症发生率低于对照组,差异有统计学意义(P=0.031)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.028)。观察组重症监护室观察时间及整体治疗时间短于对照组,差异有统计学意义(P<0.001)。结论:神经内镜微创手术治疗高血压脑出血的效果较好,其手术时间短、术中出血量少、血肿清除率高,术后并发症发生率低,患者恢复速度快。

CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗老年高血压脑出血患者的效果

目的:分析CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗老年高血压脑出血患者的效果。方法:选取2018年3月—2023年3月如东县人民医院收治的102例老年高血压脑出血患者。根据入院顺序进行编号,利用最新统计学软件生成随机序列后将其分为对照组(51例)和观察组(51例)。对照组给予保守治疗,观察组在对照组基础上给予CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗。比较两组治疗1周后临床疗效,治疗前及治疗1周后血管内皮功能、预后及生活质量,并发症。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗1周后,观察组一氧化氮(nitric oxide,NO)水平高于对照组,内皮素-1(endothelin-1,ET-1)水平低于对照组,差异有统计学意义(P<0.05)。治疗1周后,观察组改良Rankin量表(modified Rankin scale,mRS)评分低于对照组,改良Barthel指数(modified Barthel index,MBI)评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:对于老年高血压脑出血患者采取CT定位下硬通道微创穿刺引流术联合尿激酶灌注治疗效果显著,有利于改善血管内皮功能,提高预后及生活质量水平,并降低并发症发生率。

CT定位辅助下微创穿刺引流术对高血压脑出血患者神经功能缺损评分与并发症发生情况的影响

目的探讨CT定位辅助下微创穿刺引流术对高血压脑出血(HICH)患者神经功能缺损评分与并发症发生情况的影响。方法选取2019年1月至2022年3月昌邑市人民医院收治的96例HICH患者作为研究对象,按照奇偶数法分为A组与B组,每组48例。A组行CT定位辅助下微创穿刺引流术治疗,B组行小骨窗开颅血肿清除术治疗,比较两组基本手术指标、神经功能损伤程度[神经功能缺损评分(NFDS)]及日常生活能力[Barthel指数评定量表(BI)]、生命质量[脑卒中影响量表(SIS)]、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)]、并发症发生情况、不良事件发生情况。结果A组术中出血量少于B组,住院时间短于B组,血肿清除率高于B组,差异有统计学意义(P<0.05)。治疗后,两组NFDS评分均低于治疗前,BI评分均高于治疗前,且A组NFDS评分低于B组,BI评分高于B组,差异有统计学意义(P<0.05)。治疗后,两组交流、日常生活能力、移动能力、情感、参与、力气、手功能、记忆与思维评分均高于治疗前,且A组高于B组,差异有统计学意义(P<0.05)。治疗后,两组NO水平均高于治疗前,ET-1水平均低于治疗前,且A组NO水平高于B组,ET-1水平低于B组,差异有统计学意义(P<0.05)。A组并发症发生率低于B组,差异有统计学意义(P<0.05)。两组不良事件发生率比较差异无统计学意义。结论CT定位辅助下微创穿刺引流术疗效更佳,可有效减轻患者神经功能损伤,减少并发症发生,值得临床推广应用。

清震汤加减联合微创血肿清除术治疗高血压脑出血临床研究

目的:观察清震汤加减联合微创血肿清除术治疗高血压脑出血的治疗效果。方法:抽取98例高血压脑出血患者为研究对象,按照随机数字表法分为试验组和对照组各49例。对照组行微创血肿清除术,术后给予西医常规治疗,试验组在对照组基础上联合清震汤加减治疗。比较2组颅内压(ICP)、美国国立卫生院卒中量表(NIHSS)评分与格拉斯哥昏迷指数(GCS),脑水肿体积和持续时间,血清肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)、基质金属蛋白酶-9(MMP-9)水平及中医证候评分。结果:术前,2组ICP值比较,差异无统计学意义(P>0.05);术后即刻及24 h、72 h、1周,试验组相同时间点的ICP值均低于对照组(P<0.05)。术前,2组NIHSS、GCS指数评分比较,差异无统计学意义(P>0.05);术后14 d,试验组NIHSS评分低于对照组(P<0.05),GCS指数高于对照组(P<0.05)。术后,试验组脑水肿体积、脑水肿持续时间低于对照组,差异有统计学意义(P<0.05)。术前,2组血清TNF-α、MMP-9、NGF水平比较,差异无统计学意义(P>0.05)。术后14 d,2组血清TNF-α、MMP-9水平较术前下降(P<0.05),血清NGF水平较术前上升(P<0.05);且试验组血清TNF-α、MMP-9水平低于对照组(P<0.05),NGF水平高于对照组(P<0.05)。术前,2组半身不遂、口眼歪斜、神志昏蒙等中医证候评分比较,差异无统计学意义(P>0.05);术后14 d,试验组上述各项中医证候评分均低于对照组(P<0.05)。结论:微创血肿清除术联合清震汤加减治疗高血压脑出血可降低ICP,减轻卒中症状和昏迷指数,减轻脑水肿,改善中医证候及炎症反应。

立体定向微创手术治疗少量丘脑出血的临床效果

目的探索立体定向微创手术治疗少量丘脑出血的临床效果。方法回顾性分析2019年10月至2022年5月收治的110例少量丘脑出血(出血量6~15 mL)的患者。治疗组患者(55例)采用立体定向微创手术治疗,对照组患者(55例)采用保守治疗方法。使用美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷评分(GCS)及扩充版格拉斯哥预后(GOS-E)评分对所有患者进行评估,比较2组患者入院时NIHSS评分、治疗后2周和治疗后4周时NIHSS评分的变化,治疗前后血肿量、GOS-E评分的变化,并发症发生率以及出院6个月后,患者的NIHSS及GOS-E评分,并进行统计学分析。结果治疗后2周、4周,治疗组NIHSS评分、GOS-E评分均优于对照组(P<0.05);治疗后3 d和7 d,2组血肿体积均小于入院时(P<0.05),且治疗组小于对照组(P<0.05);治疗组颅内感染发生率高于对照组(P<0.05),对照组脑积水、肺部感染及下肢血栓发生率高于治疗组(P<0.05);6个月后复诊,治疗组患者NIHSS评分显著低于对照组(P<0.05),治疗组GOS-E评分高于对照组(P<0.05)。结论与保守治疗效果相比,立体定向微创手术可显著改善少量丘脑出血患者的转归和预后。

基层医院高血压脑出血个性化微创治疗的临床研究

目的探讨基层医院高血压脑出血各种微创手术方式的临床效果。方法选择符合微创手术适应证的56例高血压脑出血患者,根据不同患者采取个性化手术方式(软通道穿刺、硬通道穿刺、锁孔显微镜下血肿清除、小骨窗内镜下血肿清除、立体定向血肿穿刺抽吸引流术等)进行微创手术,观察疗效。结果56例患者术后再出血4例,再出血率7.14%。随访3~6个月,采用日常生活能力(ADL)评定:Ⅰ级8例、Ⅱ级17例、Ⅲ级24例、Ⅳ级2例、V级1例、死亡4例(包括3例因经济及对预后不良难以接受原因放弃治疗),恢复良好率87.50%,死亡率7.14%。结论基层医院高血压脑出血患者因发病时间短等情况有其特殊性,对符合手术适应证的不同患者采取个性化的微创手术方式进行干预,使得取得良好预后成为可能。

神经内镜硬通道微创治疗基底节区高血压脑出血的效果及安全性

目的:分析基底节区高血压脑出血采取神经内镜硬通道微创治疗的临床效果和安全性。方法:收集2020年1月—2023年1月盐城市第三人民医院接诊的80例基底节区高血压脑出血患者,采取随机法将患者分为两组,一组应用小骨窗开颅血肿清除术进行治疗,共40例为对照组,另一组应用神经内镜硬通道微创治疗,共40例为研究组。对比两组各项手术指标、神经缺损功能及并发症发生率。结果:治疗后3个月,研究组的卒中量表评分及格拉斯哥昏迷量表(GCS)评分明显优于对照组,差异均有统计学意义(P<0.05)。研究组住院时间明显短于对照组,血肿清除率明显高于对照组,残留血肿量明显少于对照组,差异均有统计学意义(P<0.05)。研究组手术治疗之后出现并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:临床中为基底节区高血压脑出血患者提供神经内镜硬通道微创治疗,可以帮助促进患者术后身体康复,有效改善患者的神经缺损功能,减少并发症出现。

不同微创手术方法治疗高血压脑出血老年患者的疗效研究

目的评价不同微创手术方法治疗高血压脑出血老年患者的效果。方法选取2021年3月—2023年2月莒南县人民医院神经外科收治的117例行微创手术治疗的高血压脑出血老年患者为研究对象,根据随机数表法分为3组,即微创钻孔组(n=39)、立体定向组(n=39)与神经内镜组(n=39)。微创钻孔组、立体定向组与神经内镜组分别给予微创钻孔引流术、立体定向颅内血肿清除术与神经内镜下血肿清除术治疗。比较3组疗效指标、血清指标、简易精神状态评价量表(Mini Mental State Examination,MMSE)评分与自我认同感量表(Self Identity Scale,SIS)评分。结果神经内镜组患者疗效(64.1%)优于立体定向组(56.4%)、微创钻孔组(53.8%),差异有统计学意义(χ^(2)=14.674、25.720,P均<0.05)。治疗2周后,神经内镜组神经营养因子为(6.01±0.69)ng/mL,较其余2组显著提高,差异有统计学意义(P均<0.05);神经内镜组的S-100蛋白为(0.86±0.32)μg/mL、血清铁蛋白为(277.95±19.96)ng/mL,较其余2组显著降低,差异有统计学意义(P均<0.05)。治疗6个月后,神经内镜组的SIS、MMSE评分高于其余2组,差异有统计学意义(P均<0.05)。结论与微创钻孔引流术与立体定向颅内血肿清除术比较,神经内镜下血肿清除术治疗高血压脑出血老年患者的疗效更好。

机器人辅助下HICH患者颅内血肿穿刺引流术

高血压脑出血(HICH)是一种致死率和致残率均较高的脑卒中类型,外科手术作为HICH的重要治疗方式之一,能有效解除血肿压迫、缓解颅内高压。随着神经外科手术机器人的不断完善与升级,微创外科技术在HICH治疗中已取得重大突破,机器人辅助颅内血肿穿刺引流可有效提高引流管置入精准度并缩短手术时间,在治疗HICH患者中具有明显优势。本文将介绍机器人辅助下颅内血肿穿刺引流术的详细操作步骤,为HICH患者的临床治疗提供参考。