神经内镜辅助手术治疗老年高血压性脑出血的临床观察  

Observation of Neuroendoscopy-Assisted Surgery in the Treatment of Hypertensive Cerebral Hemorrhage in the Elderly

作　　者：张亮 宋英[1] 付辉[1] 赵保钢[1] 韩光[1] 孙智宏[1] Zhang Liang;Song Ying;Fu Hui;Zhao Baogang;Han Guang;Sun Zhihong(Department of Neurosurgery,the People's Hospital of Daxing District,Beijing,102600,P.R.China)

机构地区：[1]北京市大兴区人民医院神经外科

出　　处：《老年医学与保健》2019年第3期376-380,共5页Geriatrics & Health Care

摘　　要：目的探讨神经内镜辅助手术治疗高血压性脑出血的临床效果,为治疗高血压性脑出血提供有效方法。方法选取73例老年高血压性脑出血患者,采用随机数字表法分为对照组(n=36)和观察组(n=37),对照组采用常规开颅手术治疗,观察组采用神经内镜辅助手术治疗。观察并比较2组手术时间、血肿清除率、平均引流时间、再出血率、28d病死率、以及术前、术后1d、3d、7d、14d、28d患者的格拉斯哥昏迷评分(GCS)、神经功能缺损程度评分(NIHSS)和颅内压、术后6个月预后良好率等。结果观察组手术时间、平均引流时间、再出血率和28d病死率均明显低于对照组(P<0.05),血肿清除率显著高于对照组(P<0.05)。观察组术后3d、7d、14d和28d时GCS评分均显著高于同期对照组(P<0.05)。观察组术后1d、3d、7d、14d和28d时NIHSS评分均显著低于同期对照组(P<0.05)。2组术前、术后1d、3d、7d、14d、28d时颅内压差异均无统计学意义(P>0.05)。观察组预后良好率显著高于对照组(P<0.05)。结论神经内镜辅助手术治疗老年高血压性脑出血效果优于常规开颅手术,可提高血肿清除率,降低再出血率和28d死亡率,改善患者神经功能缺失状态,提高预后良好率,具有一定的临床应用价值。Objective To explore the clinical effect of neuroendoscope-assisted surgery in the treatment of hypertensive cerebral hemorrhage.Methods 73 elderly with hypertensive cerebral hemorrhage were randomly divided into 2 groups: control group (n=36) and research group (n=37);routine craniotomy was performed on the elderly in control group while neuroendoscope- assisted surgery was performed on the elderly in research group;the operation time,hematoma clearance rate, average drainage time,rebleeding rate,28-day mortality rate,GCS score,intracranial pressure and 6-month prognosis in both groups were observed at the time point of before operation,1d,3d,7d,14d and 28d after operation and a comparative study was made between the 2 groups.Results The operation time,average drainage time,rebleeding rate and 28-day mortality were lower while the hematoma clearance rate was significantly higher in research group than those in control group (P<0.05);the GCS scores at the time point of 3,7,14 and 28 days after operation in research group were significantly higher than those in control group (P<0.05);the NIHSS scores at the time point of 1d,3d,7d,14d and 28d after operation in research group were significantly lower than those of the control group (P<0.05).There was no significant difference in intracranial pressure at the time point of before operation,1d,3d,7d,14d and 28d after operation between the 2 groups (P>0.05);the good prognosis rate in research group was significantly higher than that in control group (P<0.05).Conclusions Neuroendoscopy-assisted surgery is of superior effect to conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage in the elderly,it can promote the clearance rate of hematoma,reduce the rate of re-bleeding and the 28-day mortality, improve the neurological deficit of patients and increase the prognosis rate;it is worthy of clinical application.

关 键 词：老年 高血压性脑出血 出血性脑卒中 神经内镜 开颅手术 

分 类 号：R651.12[医药卫生—外科学]