微创与去骨瓣血肿清除术治疗高血压脑出血的效果比较及预后影响因素分析  

Comparison of minimally invasive hematoma removal and bone flap craniotomy for hypertensive intracerebral hemorrhage and analysis of prognostic factors

作　　者：杨学明 张之伟 蔡志强 李想[2] 张珩[2] 王秋石 唐辉[1] Yang Xueming;Zhang Zhiwei;Cai Zhiqiang;Li Xiang;Zhang Heng;Wang Qiushi;Tang Hui(Department of Neurosurgery,Nanchong Central Hospital,North Sichuan Medical College,Nanchong Sichuan 637000,China;Department of Neurosurgery,Langzhong People's Hospital,Nanchong Sichuan 637400,China)

机构地区：[1]川北医学院附属南充市中心医院神经外科,四川南充637000 [2]四川省阆中市人民医院神经外科,四川南充637400

出　　处：《保健医学研究与实践》2024年第12期27-32,共6页Health Medicine Research and Practice

基　　金：四川省科技计划项目(2023YFS0572)。

摘　　要：目的比较微创与去骨瓣血肿清除术治疗高血压脑出血的临床效果,并分析患者的预后影响因素,为提高高血压脑出血的治疗效果及改善患者预后提供参考。方法回顾性分析2018年2月—2023年12月川北医学院附属南充市中心医院收治的204例高血压脑出血患者的临床资料,根据治疗方案分为研究组与对照组,每组102例。对照组患者采用去骨瓣血肿清除术治疗,研究组患者采用微创血肿清除术治疗。比较2组患者的手术指标、近期疗效及半年预后情况,采用多因素logistic回归分析患者预后的影响因素。结果研究组患者手术时间短于对照组,术中出血量、术后脑水肿体积小于对照组,血肿清除率高于对照组,差异均有统计学意义(P<0.05)。研究组患者的治疗总有效率为95.10%(97/102),高于对照组的77.45%(79/102),差异有统计学意义(χ2=13.412,P<0.001);研究组患者的预后良好率为84.31%(86/102),高于对照组的25.49%(26/102),差异有统计学意义(χ2=71.273,P<0.001)。不同预后患者的性别构成及出血部位比较,差异无统计学意义(P>0.05);预后不良组患者年龄、发病至手术时间、手术时间、术中出血量、术后脑水肿体积、入院时出血量≥50 mL占比、高血压病史≥10年占比、出血破入脑室占比均大于预后良好组,术前GCS评分及血肿清除率均低于预后良好组,差异均有统计学意义(P<0.05)。以患者预后情况为因变量(预后不良=1,预后良好=0),以单因素分析有统计学意义的指标为自变量进行多因素logistic回归分析,结果显示,术前GCS评分、血肿清除率、入院时出血量、高血压病史、出血破入脑室是高血压脑出血患者预后的独立影响因素(P<0.05)。结论与去骨瓣血肿清除术相比,微创血肿清除术治疗高血压脑出血的疗效及预后更好。术前GCS评分、血肿清除率、入院时出血量、高血压病史、出血破入脑室均是高血压脑出血�Objective To compare the clinical efficacy of minimally invasive hematoma removal(MIHR)and bone flap craniotomy(BFC)in treating hypertensive intracerebral hemorrhage(HICH)and analyze prognostic factors,providing insights to optimize treatment outcomes and promote patient prognosis.Methods A retrospective analysis was conducted on 204 HICH patients admitted to Nanchong Central Hospital from February 2018 to December 2023.Patients were assigned to a study group(MIHR,n=102)and a control group(BFC,n=102)based on surgical approach.Surgical indicators,short-term efficacy,and 6-month prognosis were compared.Multivariate logistic regression was used to identify prognostic factors.Results The study group exhibited shorter time of operation,less intraoperative blood loss,smaller postoperative cerebral edema volume,and higher hematoma clearance rate compared to the control group(P<0.05).The overall response rate in the study group was higher than that in the control group[95.10%(97/102)vs.77.45%(79/102);χ2=13.412,P<0.001].The good prognosis rate at 6 months in the study group was higher than that in the control group[84.31%(86/102)vs.25.49%(26/102);χ2=71.273,P<0.001].No significant differences were observed in gender or hemorrhage location between prognosis subgroups(P>0.05).As compared with good prognosis patients,poor prognosis patients had older age,longer time from onset to surgery,greater intraoperative blood loss,larger postoperative edema volume,higher proportions of admission hematoma volume at 50 mL or more,hypertension history of 10 years or more,and intraventricular hemorrhage,but lower preoperative Glasgow Coma Scale(GCS)scores and hematoma clearance rates(P<0.05).Multivariate logistic regression analysis was performed using prognosis(poor prognosis=1,good prognosis=0)as the dependent variable and statistically significant indicators from univariate analysis as independent variables.The results showed that preoperative GCS score,hematoma clearance rate,hemorrhage volume on admission,history of hypertension,and

关 键 词：微创血肿清除术 去骨瓣血肿清除术 高血压脑出血 神经功能 血肿清除率 预后 

分 类 号：R651.12[医药卫生—外科学]