神经内镜下治疗与小骨窗开颅治疗在高血压基底节区脑出血中的对比研究  

Comparative study of neuroendoscope treatment and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage in basal ganglia

作　　者：张雷 张景周[2] 

机构地区：[1]安徽宣城中心医院,宣城242099 [2]安徽蚌埠市第三人民医院,蚌埠233000

出　　处：《中国实用神经疾病杂志》2017年第5期7-10,共4页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析神经内镜下治疗与小骨窗开颅在高血压基底节脑出血患者中的疗效及安全性。方法将我院神经外科70例高血压基底节区脑出血患者随机分为观察组(神经内镜)和对照组(小骨窗开颅术)。对比2组术中出血量、手术用时、血肿清除率、住院时间、并发症发生率、病死率;评估术后1个月2组不同年龄、出血量、术前格拉斯哥昏迷量表(GCS)和改良爱丁堡-斯堪的纳维亚量表(MESS评分)的患者及脑室出血患者日常生活行为能力表(ADL)得分。结果与对照组比较,观察组手术用时更短,术中出血量更少,血肿清除率更高,术后24hGCS较对照组高,住院时间更短;术后1个月观察组总体ADL评分较对照组高;无论是否脑室出血,术后1个月观察组患者ADL分值均较对照组高;观察组中年龄较高的患者、出血量较小的患者、术前GCS分值较高的患者、术前MESS分值较低的患者术后1个月ADL评分均较对照组高(P<0.05)。观察组1个月病死率(8.57%)与对照组比较(14.29%)无显著差异(P>0.05)。结论与小骨窗开颅相比,神经内镜下血肿清除术具有以下优势:(1)减少术中出血量,缩短手术时间,提高血肿清除率,缩短住院时间;(2)术后并发症更少,安全性更高;(3)在术前MESS评分16~30分、术前CGS评分≥9分、出血量30~50mL、年龄50~69岁的患者中疗效更好,患者术后生活能力更强。Objective To study the efficacy and safety of neuroendoscope versus small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage in basal ganglia.Methods Seventy patients with hypertensive basal ganglia hemorrhage were randomly divided into observation group(neuroendoscope group)and control group(small bone window craniotomy group).Bleeding amount,operation time,clearance rate of hematoma,hospital stays,complication rate and mortality were compared in both two groups.One month after operation,we evaluated activity of daily living(ADL)scores in patients with different ages,bleeding volume,preoperative Glasgow Coma Scale(GCS)scores and MESS scores.Results Compared with the control group,the observation group had shorter operation time,less blood loss and higher clearance rate of hematoma,more GCS scores within 24 hafter operation,shorter hospital stays and more ADL scores one month after operation(P<0.05).The older patients and those with less blood loss and higher preoperative GCS scores and MESS scores in observation group had more ADL scores than controls(P<0.05).No significant difference was found as for mortality between the two groups(8.57% vs 14.29%).Conclusion Compared with small bone window craniotomy,neuroendoscope takes several advantages as follows.Firstly,neuroendoscope can reduce the amount of blood loss,shorten the operation time,improve clearance rate of hematoma and shorten hospital stays.Secondly,there are less postoperative complications and more safety.Thirdly,neuroendoscope may be more effective in patients with MESS ranging from 16 to 30scores,preoperative GCS over 9scores and blood loss between 30 and 50mL and those aged from 50 to 69years old.

关 键 词：高血压基底节区脑出血 小骨窗开颅 神经内镜 

分 类 号：R743.34[医药卫生—神经病学与精神病学]