神经内镜与小骨窗开颅手术治疗高血压脑出血的临床疗效分析

发布时间：2018-01-29 12:10

本文关键词： 高血压脑出血神经内镜小骨窗开颅手术疗效　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文通过比较神经内镜微创手术与小骨窗开颅血肿清除手术治疗高血压幕上脑出血的多项临床指标,分析两种手术方式的疗效,为临床选择合适的微创手术方式提供依据,提高患者的临床疗效,从而改善患者的预后。方法:本次研究严格按照所设计的病例纳入及排除标准,对入选的56例临床病例进行回顾性分析。按病例所接受的治疗方法,将其分为神经内镜组(A组)和小骨窗开颅组(B组)。首先对各组病例治疗前状况包括一般特征、术前意识状态、出血量、手术时机、伴随基础疾病以及临床神经功能缺失程度等进行评价,了解术前两组的基本情况是否具有可比性。随后对其手术时间、首次血肿清除率、术中出血量,住院期间的再出血发生率、死亡率、感染率、神经功能恢复程度以及住院时间进行比较。最后进行总体转归的比较,即手术后6个月疗效对比分析。结果:(1)两组病例的一般特征、术前意识状态、出血量、手术时机、伴随基础疾病以及临床神经功能缺失程度等,经统计检验,得出各组间差异均无统计学意义(P0.05)。(2)A组平均手术时间为(1.52±0.40)h,B组平均手术时间为(2.68±0.76)h,经统计学分析后,两组结果存在差异(t=8.34,P0.01),即A组平均手术时间要小于B组。(3)A、B两组在手术中平均失血量为分别为(35.61±13.52)ml和(277.14±101.33)ml,两组间有统计学差异(t=7.84,P0.01)。(4)A、B两组术后平均残留血肿量分别为(5.31±7.15)ml、(10.48±8.67)ml,计算出血肿清除率分别为(90.12±4.32)%、(74.34±10.56)%,具有统计学差异(Z=4.38,P0.05)。(5)两组患者平均住院时间(天)分别为(8.89±2.57)和(14.56±4.34),具有统计学意义(P0.05)。(6)在术后再出血率、死亡率、感染发生率方面,两组均无统计学差异(P0.05)。(7)术前两组神经功能缺损程度分值对比无统计学差异(P0.05);手术后第1周,A、B两组神经功能缺损程度评分均低于手术前(P0.05);手术后第4周,A、B两组评分均明显低于手术前(P0.05);同期A、B两组之间神经功能缺损程度比较中,手术后第1周差异有统计学意义(P0.05),第4周有统计学差异(P0.05),说明A组术后神经功能恢复速度要优于B组。(8)术后6个月随访资料中,A组预后良好率(81.82%)高于B组良好率(65.63%)(P0.05)。结论:对于出血量30-50ml、病情较轻的幕上高血压脑出血患者,神经内镜微创手术较小骨窗开颅血肿清除术而言,是一种更具有微创、快捷、血肿清除率高、出血少、恢复快、预后好等优点手术方法。
[Abstract]:Objective: to compare the clinical indexes of endoscopic minimally invasive surgery and small bone window craniotomy in the treatment of hypertensive supratentorial intracerebral hemorrhage. To provide the basis for clinical selection of appropriate minimally invasive surgery, improve the clinical efficacy of patients, and improve the prognosis of patients. Methods: this study strictly according to the designed case inclusion and exclusion criteria. A retrospective analysis of 56 clinical cases was carried out according to the treatment methods received by the patients. The patients were divided into neuroendoscopy group (group A) and small bone window craniotomy group (group B). With the basic diseases and the degree of clinical neurological deficit to evaluate, to understand whether the two groups before the basic conditions are comparable. Then the operation time, the first hematoma clearance rate, intraoperative blood loss. The incidence of rebleeding, mortality, infection rate, degree of neurological function recovery and length of stay during hospitalization were compared. Finally, the overall outcome was compared. Results the general characteristics of the two groups, preoperative consciousness, bleeding volume, surgical timing, associated basic diseases and the degree of clinical neurological deficit were compared and analyzed. The average operation time of group A was 1.52 卤0.40 hours. The average operation time of group B was 2.68 卤0.76 h. After statistical analysis, there was a difference between the two groups. The mean operative time of group A was less than that of group B (35.61 卤13.52ml) and group B (277.14 卤101.33ml). The mean blood loss was 35.61 卤13.52ml in group A and 277.14 卤101.33ml in group B, respectively. There was statistical difference between the two groups. The mean residual hematoma volume in the two groups was 5.31 卤7.15ml. The hematoma clearance rates were calculated to be 90.12 卤4.32 and 74.34 卤10.56, respectively. The difference was statistically significant (P < 0.05). The average hospitalization time (days) was 8.89 卤2.57 and 14.56 卤4.34, respectively. There were significant differences in the rate of postoperative rebleeding, mortality and infection rate. There was no statistical difference between the two groups (P 0.05). There was no significant difference in the degree of nerve function defect between the two groups before operation (P 0.05). At the first week after operation, the scores of nerve function defect in group A and B were lower than those in group A (P 0.05) before operation. At the 4th week after operation, the scores of group A and B were significantly lower than those before operation (P 0.05). At the same time, there were significant differences in the degree of nerve function defect between the two groups at the first week after operation (P0.05), and at the 4th week (P0.05). The results showed that the recovery rate of nerve function in group A was better than that in group B (6 months). The good prognosis rate of group A (81.82) was higher than that of group B (65.63%). Conclusion: for patients with mild supratentorial hypertensive intracerebral hemorrhage, the bleeding volume is 30-50 ml. Endoscopic minimally invasive surgery is a more minimally invasive, rapid, high clearance rate, less bleeding, faster recovery and better prognosis than small bone window craniotomy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12;R544.1

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