神经内镜下血肿清除术治疗高血压脑出血的临床效果观察及预后影响因素分析  

Clinical effect observation and prognostic influencing factor analysis of hematoma removal under neuroendoscope for hypertensive intracerebral hemorrhage

作　　者：王鹏[1] 王晓曦 牛祥 王明明 WANG Peng;WANG Xiaoxi;NIU Xiang;WANG Mingming(Department of Neurosurgery,Tianshui First People's Hospital,Tianshui 741000,Gansu,China)

机构地区：[1]天水市第一人民医院神经外科,甘肃天水741000

出　　处：《外科研究与新技术(中英文)》2025年第1期43-47,共5页Surgical Research and New Technique

基　　金：天水市科技支撑计划项目任务书(2021-SHFZKJK-2889)。

摘　　要：目的 分析神经内镜下血肿清除术治疗高血压脑出血的临床效果及预后影响因素分析。方法 选择2020年7月—2023年7月收治的80例高血压脑出血患者作为研究对象,按照手术方式不同分为内镜组(神经内镜下血肿清除术)和小骨窗组(小骨窗开颅显微镜下血肿清除术),每组各40例。比较两组手术时间、术中出血量、血肿清除率和术后并发症发生情况,比较两组术前及术后预后情况[格拉斯哥预后评分量表(GOS)评分]、神经功能缺损程度[神经功能缺损评分(NFDS)]和日常生活能力[日常生活活动量表(ADL)评分]。采用多因素logistic回归分析影响内镜组患者的预后相关因素。结果 内镜组手术时间和术中出血量显著低于小骨窗组(P<0.05),内镜组血肿清除率显著高于小骨窗组(P<0.05),内镜组术后并发症发生率显著低于小骨窗组(P<0.05)。术前,两组GOS评分、NFDS和ADL评分进行比较,差异无统计学意义(P>0.05);术后,两组GOS评分、NFDS和ADL评分较术前变化显著,且内镜组优于小骨窗组(P<0.05)。多因素logistic回归分析可知,高血压病史、出血量、是否破入脑室及术前GOS评分均是影响内镜组患者预后的危险因素(P<0.05)。结论 神经内镜下血肿清除术治疗高血压脑出血可显著提高血肿清除率,缩短手术时间,降低术中出血量,减少术后并发症发生,改善预后和神经功能,提高生活自理能力,可在临床大力使用。高血压病史、出血量、是否破入脑室及术前GOS评分可能是影响神经内镜下脑内血肿清除术患者预后的危险因素。Objective To analyze the clinical effects of removal of hematoma under neuroendoscope on hypertensive cerebral hemorrhage and the potential factors affecting prognosis.Methods A total of 80 patients with hypertensive cerebral hemorrhage admitted from July 2020 to July 2023 were selected as study subjects.According to different surgical methods,they were divided into an endoscopic group(hematoma removal under neuroendoscopy)and a small bone window group(hematoma removal by small bone window craniotomy under microscope),with 40 cases in each group.Operation time,intraoperative blood loss volume,hematoma clearance rate,and postoperative complication incidence were compared between the groups.Preoperative information and postoperative prognosis[Glasgow outcome scale(GOS)score],the degree of neurological impairment[neurological functional deficit score(NFDS)],and the ability of daily living[activities of daily living(ADL)score]were compared between the two groups.Logistic regression analysis was performed of factors affecting the prognosis of patients in the endoscopic group.Results The endoscopic group showed significantly lower operation time and intraoperative blood loss volume than the small bone window group(P<0.05),significantly higher clearance rate of hematoma(P<0.05),and significantly lower incidence of postoperative complications(P<0.05).Before surgery,there was no significant difference in GOS,NFDS,and ADL scores between the two groups(P>0.05).After surgery,the three indicators of the two groups were significantly changed,and the endoscopic group had significantly better results than the small bone window group(P<0.05).The logistic analysis showed that hypertension history,blood loss volume,ventricle rupture or not,and GOS score before surgery were all risk factors affecting the prognosis of patients in the endoscopic group(P<0.05).Conclusion The treatment of hypertensive intracerebral hemorrhage by removal of hematoma under neuroendoscope can significantly increase the removal rate of hematoma,shorten oper

关 键 词：神经内镜下血肿清除术 小骨窗开颅显微镜下血肿清除术 高血压脑出血 

分 类 号：R651.1[医药卫生—外科学]