神经内镜微创术与小骨瓣开颅术治疗老年高血压脑出血患者的疗效对比研究  

Comparative study on the efficacy of minimally invasive neuroendoscopy and craniotomy with small bone flaps in the treatment of elderly patients with hypertensive cerebral hemorrhage

作　　者：谢运涛 张亚磊 刘沛涛 乔景尊 XIE Yuntao;ZHANG Yalei;LIU Peitao;QIAO Jingzun(Department of neurosurgery,Luohe second people's hospital,Luohe462000,China)

机构地区：[1]漯河市第二人民医院神经外科,河南漯河462000

出　　处：《包头医学院学报》2021年第2期12-15,共4页Journal of Baotou Medical College

摘　　要：目的:比较分析神经内镜微创术和小骨瓣开颅血肿清除术的相关量效指标,为选择合适的微创手术方法提供临床参考。方法:选择2016年12月至2019年12月接受诊治的高血压脑出血且年龄>60岁的患者共120例,根据随机数表法分为观察组(神经内镜组)60例和对照组(小骨瓣开颅组)60例,观察组采用神经内镜手术治疗,对照组采用小骨瓣开颅血肿清除术治疗,分析比较两组患者的术中情况、并发症发生率、临床疗效及转归等情况。结果:与对照组相比,观察组手术时间短,术中出血少,血肿清除率高于对照组,且引流时间短于对照组(均为P<0.05);术后48 h炎性指标肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、C-反应蛋白(CRP)水平,观察组低于对照组(P<0.05);观察组颅内感染、再出血发生率低于对照组(P<0.05),而肺感染及30 d死亡率两组相比差异无统计学意义(P>0.05);两组术后功能与转归评估比较,观察组格拉斯哥昏迷评分(GCS)更高,美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分更低(P<0.05)。结论:与小骨瓣开颅术相比,神经内镜手术治疗老年高血压脑出血更有效,更安全,转归及预后更好。Objective:To compare and analyze the relevant dose-effect indicators of neuroendoscopic minimally invasive surgery and small bone flap craniotomy for hematoma removal,and to provide clinical reference for the selection of appropriate minimally invasive surgical methods.Methods:A total of 120 patients with hypertensive cerebral hemorrhage who were diagnosed and treated in our hospital from December 2016 to December 2019 and those who were older than 60 years of age were selected and divided into a study group(neuroendoscopy group)according to the random number table method.And the control group(small bone flap craniotomy group)were 60 cases.The study group was treated with neuroendoscopy,and the control group was treated with small bone flap craniotomy.The intraoperative situation,complication rate,clinical efficacy and outcome of the two groups of patients were analyzed and compared.Results:Compared with the control group,the study group had shorter operation time,less intraoperative bleeding,hematoma clearance rate was higher than that of the control group,and the drainage time was shorter than that of the control group.The differences were statistically significant(P<0.05).Comparison of inflammatory indicators TNF-α,IL-6,and CRP at 48 hours after operation in the two groups:the level of the study group was lower than that of the control group,and the difference was statistically significant(P<0.05).Comparison of complications between the two groups:the incidence of intracranial infection and rebleeding in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05),while lung infection and 30-day mortality were not significantly different between the two groups(P>0.05).Comparison of postoperative function and outcome assessment between the two groups:the study group had a higher GCS score and a lower NIHSS score,which was significantly different from the control group(P<0.05).Conclusion:Compared with small bone flap craniotomy,neuroendoscopic surgery is more

关 键 词：高血压 脑出血 神经内镜 小骨瓣开颅术 

分 类 号：R65[医药卫生—外科学]