神经内镜微创手术治疗高血压脑出血病人的手术效果及对病人神经功能的影响  

Minimally invasive neuroendoscopic surgery for patients with HICH and its effect on neurological function

作　　者：石海平[1] 罗可[1] 黄伟[1] SHI Haiping;LUO Ke;HUANG Wei(Department of Neurosurgery,Suining City Central Hospital,Sichuan Province,Suining 629000,China)

机构地区：[1]四川省遂宁市中心医院神经外科

出　　处：《临床外科杂志》2019年第12期1029-1032,共4页Journal of Clinical Surgery

摘　　要：目的探讨神经内镜微创手术治疗高血压脑出血(HICH)病人的手术效果及对病人神经功能的影响。方法 2015年1月~2018年2月在我院手术治疗的HICH病人110例,根据手术方法分为微创组48例(神经内镜手术治疗)、开颅组62例(小骨窗开颅手术治疗);对比两组的手术时间、手术出血量、血肿清除率、ICU时间、住院总时间、手术前后不同时间病人的美国国立卫生研究院卒中量表评分(NIHSS)、简易精神状态量表(MMSE)、日常生活活动能力(ADL)量表评分。结果微创组和开颅组的手术时间分别为(140.6±22.1)分钟和(179.4±29.5)分钟,手术出血量分别为(37.2±8.6)ml和(187.5±32.0)ml,ICU时间分别为(4.2±1.0)天和(5.9±1.5)天,住院总时间分别为(15.8±2.0)天和(19.4±2.8)天,两组比较差异有统计学意义(P<0.05);微创组的血肿清除率为(90.6±6.2)%,开颅组为(86.1±5.8)%,两组比较差异有统计学意义(P<0.05);在手术前,两组NIHSS评分对比差异无统计学意义(P>0.05);微创组病人术后4周及术后3个月的NIHSS评分分别为13.9±3.7和6.8±1.8,开颅组对应时间点分别为15.5±4.1和8.2±2.1,两组比较差异有统计学意义(P<0.05);术后3个月,微创组的MMSE评分(24.8±2.8)高于开颅组(22.5±3.6)(P<0.05);术后4周及术后3个月,微创组的ADL评分(49.8±6.2,71.3±5.8)均高于开颅组(46.3±5.7,67.5±6.2)(P<0.05)。结论神经内镜微创手术治疗HICH较小骨窗开颅手术具有更好的临床效果,尤其是血肿清除及术后病人神经功能、认知功能、日常生活活动能力的恢复方面具有一定的优势。Objective To investigate the effect of minimally invasive neuroendoscopic surgery on patients with hypertensive cerebral hemorrhage(HICH)and its effect on nerve function.Methods Retrospective study of 110 patients with HICH in our hospital(January 2015 to February 2018)was conducted.According to the surgical method,48 patients in the minimally invasive group(neuroendoscopic surgery)and 62 patients in the craniotomy group(small bone window)were divided into craniotomy.Treatment);Comparison between the two groups of operation time,surgical bleeding volume,hematoma clearance rate,ICU days,total hospital time,patients with different times before and after the operation National Institutes of Health stroke scale score(NIHSS),simple mental state scale(MMSE),Daily Living Activity Ability(ADL)Scale score.Results Surgery time of invasive group and craniotomy group was(140.6±22.1)min and(179.4±29.5)min,while surgical hemorrhage was(37.2±8.6)ml and(187.5±32.0)ml,ICU time was(4.2±1.0)d and(5.9±1.5)d,total hospitalization time was(15.8±2.0)d and(19.4±2.8)d,respectively.For comparison,the minimally invasive group was lower than the craniotomy group(P<0.05);The hematoma clearance rate in the minimally invasive group[(90.6±6.2)%] was higher than that in the craniotomy group[(86.1±5.8)%](P<0.05);Before the operation,there was no statistically significant difference between the two groups of NIHSS scores(P>0.05),4 weeks after surgery and 3 months after surgery,the NIHSS score was gradually reduced in both groups(P<0.05).The NIHSS score(13.9±3.7,6.8±1.8)of the minimally invasive group was lower than that of the craniotomy group at the corresponding time(15.5±4.1,8.2±2.1)(P<0.05);In the 3 months after surgery,the MMSE score(24.8±2.8)in the minimally invasive group was higher than that in the craniotomy group(22.5±3.6)(P<0.05);After 4 weeks and 3 months after surgery,the ADL score(49.8±6.2,71.3±5.8)in the minimally invasive group was higher than that in the craniotomy group(46.3±5.7,67.5±6.2)(P<0.05).Conclusion Ne

关 键 词：神经内镜 微创手术 高血压脑出血 神经功能 

分 类 号：R651.1[医药卫生—外科学]