神经内镜微侵袭手术在高血压脑出血中的临床疗效及预后  

Clinical efficacy and prognosis of neuro-endoscopic minimally invasive surgery in HICH

作　　者：裴献光[1] 高芳 许亚宁 王志强[1] 魏海亮[1] PEI Xianguang;GAO Fang;XU Yaning;WANG Zhiqiang;WEI Hailiang(First Department of Neurosurgery,Handan First Hospital,Handan,Hebei 056002,China;不详)

机构地区：[1]邯郸市第一医院神经外一科,河北邯郸056002 [2]邯郸市第一医院外三科,河北邯郸056002

出　　处：《中国临床研究》2023年第8期1157-1161,共5页Chinese Journal of Clinical Research

基　　金：河北省医学科学研究课题(20200186)。

摘　　要：目的分析高血压脑出血(HICH)患者行神经内镜微侵袭手术的临床疗效及影响预后的因素。方法选取2020年1月至2021年12月邯郸市第一医院收治的HICH患者100例,随机分为对照组(n=50)和观察组(n=50)。对照组行小骨窗开颅血肿清除术,观察组行神经内镜微侵袭手术。比较两组血肿清除情况、美国国立卫生院卒中量表(NIHSS)和日常生活活动能力(ADL)、预后结局。根据预后将观察组分为预后良好亚组(n=37)和预后不良亚组(n=13),对影响预后的因素进行分析。结果观察组术中出血量、术后残余血肿量均少于对照组,血肿清除率高于对照组(P<0.05)。术后1个月,观察组预后良好率高于对照组(74.00%vs 48.00%,χ^(2)=7.104,P<0.05)。观察组预后良好亚组术前MAP[(122.57±7.88)mmHg vs(130.26±8.97)mmHg,t=2.921,P<0.05]、血肿量[(39.51±3.65)mL vs(45.06±3.14)mL,t=4.877,P<0.05]、NIHSS评分[(15.63±1.23)分vs(18.64±1.25)分,t=2.921,P<0.05]均低于预后不良亚组,术前GCS评分高于预后不良亚组[(10.84±2.39)分vs(8.41±2.26)分,t=3.196,P<0.05]。结论神经内镜微侵袭手术治疗HICH患者有助于血肿清除、神经功能恢复,进而改善预后。术前MAP、血肿量、GCS、NIHSS与预后有关。Objective To analyze the clinical efficacy and prognostic influencing factors of neuro-endoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage(HICH).Methods A total of 100 patients with HICH admitted to Handan First Hospital from January 2020 to December 2021 were randomly divided into control group(n=50)and observation group(n=50).The control group underwent small bone window craniotomy for hematoma debridement,and the observation group underwent neuro-endoscopic minimally invasive surgery.The hematoma clearance,National Institutes of Health Stroke Scale(NIHSS),Activity of Daily Living(ADL)and prognosis were compared between two groups.According to the prognosis,patients in observation group were divided into good prognosis sub-group(n=37)and poor prognosis sub-group(n=13),and the influencing factors were analyzed.Results The intraoperative blood loss and postoperative residual hematoma in observation group were less than those in control group,and the hematoma clearance rate was higher than that in control group(P<0.05).One month after operation,the good prognosis rate of observation group was higher than that of control group(74.00%vs 48.00%,χ^(2)=7.104,P<0.05).The preoperative MAP[(122.57±7.88)mmHg vs(130.26±8.97)mmHg,t=2.921,P<0.05],hematoma volume[(39.51±3.65)mL vs(45.06±3.14)mL,t=4.877,P<0.05],NIHSS score[(15.63±1.23)vs(18.64±1.25),t=2.921,P<0.05]of the good prognosis subgroup were all lower than those of the poor prognosis subgroup,and preoperative GCS score was higher than that of the poor prognosis subgroup[(10.84±2.39)vs(8.41±2.26),t=3.196,P<0.05].Conclusion Neuro-endoscopic minimally invasive surgery for HICH patients can help to clear hematoma,restore nerve function and improve prognosis.And preoperative MAP,hematoma volume,GCS,and NIHSS are associated with prognosis.

关 键 词：高血压脑出血 神经内镜 微侵袭手术 平均动脉压 血肿量 格拉斯哥昏迷评分 

分 类 号：R743[医药卫生—神经病学与精神病学]