微创钻孔引流术和小骨窗颅内血肿清除术对高血压性基底节区中等量脑出血的疗效和预后比较

Comparison of efficacy and prognosis of minimally invasive drilling drainage and small bone window cranial hematoma clearance in treatment of moderate cerebral hemorrhage in hypertensive basal ganglia

摘要:

目的 对比微创钻孔引流术和小骨窗颅内血肿清除术对高血压性基底节区中等量脑出血的疗效和预后。方法 选取2016年5月至2018年5月广西省象州县人民医院神经外科收治的84例高血压基底节区中等量脑出血患者作为研究对象,按随机数表法分为微创钻孔引流术(研究组)和小骨窗颅内血肿清除术(对照组),每组各42例。比较2组患者的手术时间、术中出血量、血肿清除率、术后并发症和再出血情况；记录术后3周时患者格拉斯哥预后评分(GOS)和格拉斯哥昏迷评分(GCS),以及术后3个月时日常生活能力(ADL)评级和病死率。采用SPSS 22.0软件对数据进行统计分析。根据数据类型,组间比较采用t检验或卡方检验。结果 与对照组比较,研究组患者手术时间和术中出血量显著减少,肺部感染、消化道出血发生率显著降低,差异有统计学意义(P<0.05),但2组血肿清除率比较差异无统计学意义(P＞0.05)。与对照组比较,研究组患者术后3周时的GOS[(3.4±0.6)和(3.1±0.9)分,P=0.347]和GCS[(11.6±1.3)和(11.2±1.7)分,P=0.539] 评分比较,差异均无统计学意义。术后3个月内,对照组和研究组患者病死率[4.76%(2/42)和2.38%(1/42),P=0.557]、术后3个月时ADL优良率[78.57%(33/42)和88.09%(37/42),P=0.242]比较差异均无统计学意义。结论 小骨窗颅内血肿清除术和微创钻孔引流术治疗对高血压基底节区中等量脑出血均有较好的疗效,能有效清除血肿,而微创钻孔引流术手术时间更短,并发症更少,应用价值更优。

Abstract:

Objective To compare the efficacy and prognosis of minimally invasive drilling drainage (MIDD) and small bone window cranial hematoma clearance (SBWCHC) in patients with moderate cerebral hemorrhage in hypertensive basal ganglia. Methods From May 2016 to May 2018,84 patients with moderate intracerebral hemorrhage in hypertensive basal ganglia were selected, who were treated in the Department of Neurosurgery of Xiangzhou People′s Hospital of Guangxi Province. The patients were rando-mized into the MIDD (study) group and the SBWCHC (control) group, with 42 in each group. The two groups were compared statistically in the operation time, intraoperative bleeding volume, hematoma clearance rate, postoperative complications, and rebleeding. Glasgow outcome score (GOS) and Glasgow coma score (GCS) at 3 weeks, activity of daily life (ADL) rating and mortality at 3 months were recorded. SPSS statistics 22.0 was used to analyze the data, and depending on data type, t test or Chi square test was used for the comparison between groups. Results Compared with control group, the operation time, amount of bleeding, incidence of pulmonary infection and gastrointestinal bleeding in the study group were significantly reduced (P<0.05). But no significant difference was observed between the two groups in the clearance rate of hematoma (P>0.05), GOS [(3.4±0.6) vs (3.1±0.9), P=0.347], and GCS [(11.6±1.3) vs (11.2±1.7), P=0.539] at 3 weeks, and fatality rate [4.76%(2/42) vs 2.38%(1/42), P=0.557] andADL excellence rate [78.57%(33/42) vs 88.09%(37/42), P=0.242] at 3 months. Conclusion Small bone window cranial hematoma clearance and minimally invasive drilling drainage are both effective in moderate cerebral hemorrhage in hypertensive basal ganglia and are able to effectively remove hematoma, but drilling drainage requires relatively shorter operation time and results in fewer complications, whose application is preferred.