神经内镜下脑内血肿清除术治疗老年高血压脑出血的疗效及预后影响因素分析  

Analysis of the therapeutic efficacy and prognostic factors of endoscopic removal of intracerebral hematoma in elderly patients with hypertensive intracerebral hemorrhage

作　　者：蒋超超 章元 胡夷 苏强 张云天 辛志成[1] JIANG Chaochao;ZHANG Yuan;HU Yi;SU Qiang;ZHANG Yuntian;XIN Zhicheng(Department of Aural Sursery,the 72nd Army Hospital of the Chinese People's Liberation Army,Huzhou 313000,China)

机构地区：[1]中国人民解放军陆军第七十二集团军医院脑外科,湖州313000

出　　处：《心电与循环》2023年第6期530-535,共6页Journal of Electrocardiology and Circulation

摘　　要：目的探讨神经内镜下脑内血肿清除术治疗老年高血压脑出血的疗效及预后影响因素。方法选取2018年11月至2021年11月中国人民解放军陆军第七十二集团军医院收治的122例老年高血压脑出血患者为研究对象,其中实施神经内镜下脑内血肿清除术60例,为内镜组;实施开颅血肿清除术62例,为开颅组。比较两组患者手术情况、近期疗效、颅内压变化、神经功能[采用神经功能缺损程度评分(NDS)评价]、日常生活能力[采用日常生活活动能力量表(ADL)评价]、术后并发症以及术后6个月预后情况等指标,采用多因素logistic回归模型分析内镜组患者预后不良的影响因素。结果与开颅组比较,内镜组患者手术时间明显较短,术中出血量及术后甘露醇使用量均较少,血肿清除率及总有效率均较高,差异均有统计学意义(均P<0.05)。与术前比较,两组患者术后3d及术后1周颅内压均明显降低,且内镜组均明显低于开颅组,差异均有统计学意义(均P<0.05)。两组患者术后6个月ADL评分较术前均明显升高(均P<0.05),且内镜组明显高于对照组(P<0.05);内镜组患者术后6个月NDS较术前明显降低(P<0.05),且低于开颅组(P<0.05)。内镜组术后并发症总发生率明显低于开颅组(P<0.05),预后良好率明显高于开颅组(P<0.05)。高血压病史≥10年(OR=5.417)、出血破入脑室(OR=6.267)、入院时CT显示血肿量≥50 mL(OR=7.022)、术前格拉斯哥昏迷量表(GCS)评分(OR=8.156)是内镜组患者预后不良的独立影响因素(均P<0.05)。结论神经内镜下脑内血肿清除术治疗老年高血压脑出血疗效明显,能提高血肿清除率,降低颅内压,减少甘露醇使用量;临床上可根据高血压病史、出血破入脑室、入院时CT显示血肿量、术前GCS等因素及时对患者制定针对性的诊疗方案进行干预,以改善患者预后。Objective To explore the therapeutic efficacy and prognostic factors of endoscopic removal of intracerebral hematoma in elderly patients with hypertensive intracerebral hemorrhage.Methods A total of 122 elderly patients with hypertensive intracerebral hemorrhage admitted to the 72nd Army Hospital of the Chinese People's Liberation Army from November 2018 to November 2021 were selected.Among them,60 patients underwent endoscopic removal of intracerebral hematoma(endoscopy group)and 62 patients underwent craniotomy for hematoma removal(craniotomy group).The surgical conditions,short-term efficacy,intracranial pressure changes,neurological function[evaluated using the neurological deficit score(NDS)],daily life ability[evaluated using the activities of daily living scale(ADL)],postoperative complications,and postoperative 6-month prognosis were compared between the two groups.Multivariate logistic regression analysis was used to identify the factors influencing poor prognosis in the endoscopy group.Results Compared with the craniotomy group,the endoscopy group had significantly shorter operation time,less intraoperative bleeding and postoperative mannitol usage,higher hematoma clearance rate and overall effective rate,with all differences being statistically significant(all P<0.05).Compared with preoperative values,both groups showed a significant decrease in intracranial pressure at 3 days and 1 week postoperatively,with the endoscopy group exhibiting significantly lower intracranial pressure than the craniotomy group at both time points(all P<0.05).The postoperative ADL scores at 6 months were significantly higher than the preoperative scores in both groups(all P<0.05),and the endoscopy group had significantly higher scores than the craniotomy group(P<0.05).The NDS scores in the endoscopy group decreased significantly at 6 month posoperatively compared to preoperative values(P<0.05)and was lower than those in the craniotomy group(P<0.05).The overall incidence of postoperative complications was significantly lower

关 键 词：神经内镜 高血压脑出血 颅内压 预后 影响因素 

分 类 号：R651.1[医药卫生—外科学]