小骨窗开颅与神经内镜下治疗高血压基底节区脑出血疗效的对比研究
发布时间：2018-12-10 20:05
【摘要】：研究背景:高血压基底节区脑出血具有高发病率、高死亡率和高致残率的特点,严重危害着患者的健康和生命。手术治疗是高血压基底节区脑出血重要的治疗方法,然而许多研究表明,开颅手术治疗并不一定能获得优于保守治疗的疗效。神经内镜手术是应用于高血压基底节区脑出血的微创手术方法,但是其适用范围和临床疗效尚未得到充分研究。研究方法:本研究收集了2012年5月到2014年5月就治于延安大学附属医院神经外科内镜辅助下血肿清除手术治疗高血压基底节区脑出血(神经内镜组)患者24例,并随机选取了经小骨窗开颅血肿清除手术治疗高血压基底节区脑出血(小骨窗组)患者50例进行对照研究。对比了两组患者手术时间、术中出血量、血肿清除率、术后住院时间、死亡率、术后手术相关并发症发生率、术后24小时格拉斯哥昏迷评分法(GCS)评分、术后1月和6月日常生活行为能力量表(ADL)评分。并按照患者年龄、出血量、脑室出血、术前改良爱丁堡-斯堪的纳维亚评分(MESSS)以及术前GCS评分进行分组,分析各亚组两种手术术后1月和6月ADL评分的差异。研究结果:两手术组间性别构成比、年龄、入院时收缩压、出血量、出血部位、有无脑室出血、术前GCS评分以及术前MESSS评分均无显著统计学差异(p0.05);相对于小骨窗组,神经内镜组拥有更短的手术时间、更低的手术出血量、更高的血肿清除率以及更少的术后住院时间(p0.05);两手术组间术后死亡率、手术相关并发症发生率、术后24小时GCS评分增加无显著差异(p0.05);对比不同亚组人群两种手术术后1月及术后6月患者日常生活行为能力量表(ADL)评分发现,神经内镜手术在出血量为30-50ml、术前MESSS评分为16-30分,术前GCS评分≥9分的患者中,术后1月及术后6月平均ADL评分高于小骨窗开颅手术(p0.05)。结论:1.相对于小骨窗开颅减压血肿清除手术,内镜辅助下血肿清除手术治疗高血压基底节区脑出血手术时间短、手术出血量少、血肿清除率高、术后住院时间短;2.内镜辅助下血肿清除手术与小骨窗开颅血肿清除手术治疗高血压基底节区脑出血的术后手术相关并发症发生率、死亡率以及术后早期疗效无显著差别;3.内镜辅助下血肿清除手术治疗高血压基底节区脑出血至少可以获得与小骨窗开颅减压血肿清除手术相当的远期疗效,在出血量为30-50ml、术前MESSS评分16-30分以及术前GCS评分≥9分的高血压基底节区脑出血患者中,神经内镜手术的远期疗效优于小骨窗开颅手术。4.内镜辅助下血肿清除手术是高血压基底节区脑出血安全有效的手术治疗方法。
[Abstract]:Background: hypertensive basal ganglia intracerebral hemorrhage has the characteristics of high morbidity, high mortality and high disability rate, which seriously endangers the health and life of patients. Surgical treatment is an important treatment for hypertensive intracerebral hemorrhage in basal ganglia. However, many studies have shown that craniotomy is not always superior to conservative treatment. Endoscopic neurosurgery is a minimally invasive method for hypertensive basal ganglia hemorrhage, but its scope of application and clinical efficacy have not been fully studied. Methods: from May 2012 to May 2014, 24 patients with hypertensive basal ganglia intracerebral hemorrhage (endoscope group) were treated with endoscopic hematoma clearance under endoscopes in the affiliated hospital of Yan'an University. Fifty patients with hypertensive basal ganglia intracerebral hemorrhage (small bone window group) were selected randomly. The operative time, intraoperative bleeding volume, hematoma clearance rate, postoperative hospitalization time, mortality rate, postoperative complications, (GCS) score of Glasgow coma score at 24 hours after operation were compared between the two groups. One month and six months after operation, the (ADL) score of ADL was evaluated. The patients were divided according to age, bleeding volume, intraventricular hemorrhage, preoperative modified Edinburgh Scandinavia score (MESSS) and preoperative GCS score. The difference of ADL scores between the two subgroups was analyzed at 1 month and 6 months after operation. Results: there was no significant difference in sex composition, age, systolic blood pressure (SBP), bleeding volume, location of bleeding, ventricular hemorrhage, preoperative GCS score and preoperative MESSS score between the two groups (p0.05). Compared with the small bone window group, the neuroendoscopy group had shorter operation time, lower blood loss, higher hematoma clearance rate and less postoperative hospitalization time (p0.05). There was no significant difference between the two groups in the postoperative mortality, the incidence of operation-related complications and the increase of GCS score at 24 hours after operation (p0.05). Compared with the (ADL) score of ADL in patients with different subgroups after 1 month and 6 months after operation, it was found that the bleeding volume of neuroendoscopy was 30-50 ml, and the preoperative MESSS score was 16-30 points. In the patients with preoperative GCS score 鈮，
本文编号：2371127
[Abstract]:Background: hypertensive basal ganglia intracerebral hemorrhage has the characteristics of high morbidity, high mortality and high disability rate, which seriously endangers the health and life of patients. Surgical treatment is an important treatment for hypertensive intracerebral hemorrhage in basal ganglia. However, many studies have shown that craniotomy is not always superior to conservative treatment. Endoscopic neurosurgery is a minimally invasive method for hypertensive basal ganglia hemorrhage, but its scope of application and clinical efficacy have not been fully studied. Methods: from May 2012 to May 2014, 24 patients with hypertensive basal ganglia intracerebral hemorrhage (endoscope group) were treated with endoscopic hematoma clearance under endoscopes in the affiliated hospital of Yan'an University. Fifty patients with hypertensive basal ganglia intracerebral hemorrhage (small bone window group) were selected randomly. The operative time, intraoperative bleeding volume, hematoma clearance rate, postoperative hospitalization time, mortality rate, postoperative complications, (GCS) score of Glasgow coma score at 24 hours after operation were compared between the two groups. One month and six months after operation, the (ADL) score of ADL was evaluated. The patients were divided according to age, bleeding volume, intraventricular hemorrhage, preoperative modified Edinburgh Scandinavia score (MESSS) and preoperative GCS score. The difference of ADL scores between the two subgroups was analyzed at 1 month and 6 months after operation. Results: there was no significant difference in sex composition, age, systolic blood pressure (SBP), bleeding volume, location of bleeding, ventricular hemorrhage, preoperative GCS score and preoperative MESSS score between the two groups (p0.05). Compared with the small bone window group, the neuroendoscopy group had shorter operation time, lower blood loss, higher hematoma clearance rate and less postoperative hospitalization time (p0.05). There was no significant difference between the two groups in the postoperative mortality, the incidence of operation-related complications and the increase of GCS score at 24 hours after operation (p0.05). Compared with the (ADL) score of ADL in patients with different subgroups after 1 month and 6 months after operation, it was found that the bleeding volume of neuroendoscopy was 30-50 ml, and the preoperative MESSS score was 16-30 points. In the patients with preoperative GCS score 鈮，
本文编号：2371127
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