神经内镜与软通道治疗高血压脑出血术后神经功能及生活能力对比分析  

Effects of neuroendoscopic intracranial hematoma removal and soft channel hematoma puncture and drainage on postoperative neurological function and living ability of patients with hypertensive intracerebral hemorrhage

作　　者：黄伟[1] 郭凤 傅楚华 李荣伟 冯波[1] 孙立鹏[1] 柳亚岐 徐东宝[1] HUANG Wei;GUO Feng;FU Chuhua;LI Rongwei;FENG Bo;SUN Lipeng;LIU Yaqi;XU Dongbao(Department of Neurosurgery,Hanzhong Central Hospital,Hanzhong Shaanxi 723000,China)

机构地区：[1]汉中市中心医院神经外科,陕西汉中723000 [2]汉中市中心医院妇科,陕西汉中723000 [3]襄阳市第一人民医院神经外科,湖北襄阳441000

出　　处：《中国急救复苏与灾害医学杂志》2022年第6期755-758,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：湖北省卫生健康委员会科研项目(编号:WJ2021F072);陕西省卫生健康科研基金项目(编号:2018C003)。

摘　　要：目的探讨神经内镜颅内血肿清除术与软通道微创引流术治疗高血压脑出血(HICH)对患者术后神经功能和生活质量的作用。方法选取汉中市中心医院2016年6月—2021年1月收治的HICH患者122例,按照随机数字表法分为对照组、观察组各61例。对照组给予软通道穿刺引流术治疗,观察组给予神经内镜微创手术治疗。对两组患者术前和术后的1周、5周、10周进行抽血检查。比较两组患者血肿清除率,对比术前和术后5周的氧化应激指标、神经功能、生活能力,比较两组术前和术后1周的并发症。结果观察组血肿清除率比对照组高,但比较差异无统计学意义(P>0.05);术后两组SOD水平均升高(P<0.05),MDA水平均降低(P<0.05),观察组SOD水平高于对照组(P<0.05),MDA水平低于对照组(P<0.05);术后观察组,ADL评分较对照组高(P<0.05),NIHSS评分较对照组低(P<0.05);观察组并发症发生率6.56%明显低于对照组19.67%(P<0.05),且观察组的恢复率在93.44%而对照组的恢复率在80.33%。结论神经内镜颅内血肿清除术与软通道微创引流术治疗HICH均具有较好血肿清除率,但患者神经内镜术后应激反应较轻,神经功能和日常生活能力更好,且并发症较少。Objective To analyze the effects of neuroendoscopic intracranial hematoma removal and soft channel hematoma puncture and drainage on postoperative neurological function and living ability of patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 122 patients with HICH in our hospital from June 2016 to January 2021 were enrolled,and divided into two groups by random number table methods,each with 61 cases.Control group received soft channel hematoma puncture and drainage,while observation group received neuroendoscopic intracranial hematoma removal.At the baseline,1 week,5 weeks and 10 weeks of treatment,blood examinations were performed,and the hematoma clearance rate was compared;Oxidative stress markers,neurological function,and living ability at the baseline and 5 weeks after treatment were compared.The complication rate at post-treatment 1 week was also compared between the two groups.Results The hematoma clearance rate was higher in observation group than in control group,with no statistical difference(P>0.05).After surgery,there was an increase in superoxide dismutase(SOD)level and a decrease in malondialdehyde(MDA)level in both groups(P<0.05);Compared with control group,observation group had significantly higher SOD level and lower MDA level(P<0.05).Observation group had significantly higher Activity of Daily Living(ADL)score and lower National Institute of Health Stroke Scale(NIHSS)score than those of control group after surgery(P<0.05).The complication rate was 6.56%in observation group,which was significantly lower than 19.67%in control group(P<0.05).The recovery rate was 93.44%in observation group and 80.33%in control group.Conclusion Both neuroendoscopic hematoma removal and soft-channel drainage are effective in the treatment of HICH,however,neuroendoscopic hematoma removal has the advantages of milder stress response,less complication,and better neurological function and living ability.

关 键 词：神经内镜微创手术 软通道穿刺引流术 高血压脑出血 神经功能 

分 类 号：R651.1[医药卫生—外科学]