神经内镜微创术结合LCFD术对高血压脑出血患者症状、预后及影响术后生活质量的Logistics分析  

Logistics analysis on effect of neuroendoscopic minimally invasive surgery combined with LCFD on the symptoms,prognosis and quality of life of patients with HICH

作　　者：刘胜华[1] 周政 唐协林[1] 黎乾科[1] 刘怡东[1] 赵超[1] 肖奎[1] 羊飞龙[1] 何绍勇 罗静 夏湘平[3] 叶勇强[4] LIU Sheng-hua;ZHOU Zheng;TANG Xie-lin(Department of Neurosurgery, Third Affiliated Hospital of North Sichuan Medical College, Mianyang 621100, China)

机构地区：[1]川北医学院附属三台医院神经外科,绵阳621100 [2]陆军军医大学第二附属医院神经外科 [3]遵义医学院附属医院神经外科 [4]四川省资阳市第一人民医院神经外科

出　　处：《临床神经外科杂志》2021年第1期80-84,共5页Journal of Clinical Neurosurgery

基　　金：四川省医学会科研课题计划(S15056);绵阳市卫生健康委科技计划项目(201953)。

摘　　要：目的研究神经内镜微创术结合腰大池持续引流(LCFD)术治疗高血压脑出血(HICH)的预后及其影响因素。方法66例HICH患者随机分为观察组及对照组,每组33例。观察组患者采用神经内镜微创术结合LCFD治疗,对照组患者采用标准骨瓣开颅血肿清除术结合LCFD治疗。比较两组患者的手术相关指标,以及手术前后格拉斯哥昏迷量表(GCS)评分、格拉斯哥预后量表(GOS)评分、日常生活活动能力(ADL)评分、Epworth嗜睡量表(ESS)评分和预后生活质量SF-36评分;分析影响术后预后的因素。结果观察组患者的手术时间及术中出血量显著低于对照组,血肿清除率显著高于对照组;术后的GCS、GOS、ADL、ESS评分及SF-36评分显著高于对照组(均P<0.001)。多因素分析显示,与子女同住、吸烟、饮酒、脑出血量、脑中线移位、脑出血到手术时间、破入脑室为脑出血预后的独立影响因素。结论神经内镜微创术结合LCFD对HICH具有较好的疗效,患者的预后较好。同时应及时对患者是否与子女同住、吸烟、饮酒及脑出血量、脑中线移位、脑出血到手术时间、破入脑室进行了解与监测;并早期开展康复治疗干预。Objective To explore the effect of neuroendoscopic minimally invasive surgery combined with lumbar cerebrospinal fluid drainage(LCFD)on the symptoms,prognosis and quality of life of patients with hypertensiveintracerebralhemorrhage(HICH).Methods 66 patients with hypertensive intracerebral hemorrhage were randomly divided into observation group and control group,33 cases in each group.Patients in the observation group were treated with endoscopic minimally invasive surgery combined with LCFD,while patients in the control group were treated with standard craniotomy combined with LCFD.The perioperative indexes,GCS,GOS,ADL,ESS scores and prognosis of the two groups were compared,and the factors influencing the quality of life were analyzed.Results The operation time and intraoperative blood loss of the observation group were significantly lower than those of the control group,and the hematoma clearance rate was significantly higher than that of the control group;the Glasgow coma scale(GCS),Glasgow outcome score(GOS),activities of daily living scale(ADL),Epworth sleepiness scale(ESS)scores and SF-36 scores of the observation group were significantly higher than those of the control group(all P<0.001).Multivariate analysis showed that living with children,smoking,drinking,amount of cerebral hemorrhage,midline shift,time from cerebral hemorrhage to operation,and ventricular rupture were independent prognostic factors.Conclusion Neuroendoscopic minimally invasive surgery combined with LCFD has good curative effect and good prognosis in patients with hich.At the same time,we should timely understand and monitor whether the patients live with their children,smoking,drinking and the amount of intracerebral hemorrhage,midline shift of brain,the time from cerebral hemorrhage to operation,and break into ventricles,and carry out early rehabilitation intervention.

关 键 词：高血压脑出血 神经内镜微创术 腰大池持续引流 预后 影响因素 

分 类 号：R651[医药卫生—外科学] R743.2[医药卫生—神经病学与精神病学]