微创穿刺术与小骨窗血肿清除术治疗高血压脑出血的临床对照研究

目的探讨微创穿刺术与小骨窗血肿清除术治疗高血压脑出血的临床疗效及安全性。方法将106例经CT确诊的高血压脑出血患者根据治疗适应证和家属意见分为微创穿刺术组和小骨窗血肿清除术组,每组各53例。分别根据入组情况行微创穿刺术或小骨窗血肿清除术,于治疗结束后1、2、4周进行神经功能缺损程度评分,并进行临床疗效评价,观察手术治疗的病死率。结果术后1周,两组患者神经功能缺损程度评分与术前比较差异无统计学意义(P>0.05);术后2周及4周,两组神经功能缺损程度评分显著低于术前(P<0.05),微创穿刺术组神经功能缺损程度评分减少较小骨窗血肿清除术组更明显,两组比较差异有统计学意义(P<0.05)。小骨窗血肿清除术组术后总有效率显著低于微创穿刺术组(P<0.05)。微创穿刺术组病死率与小骨窗血肿清除术组比较,差异无统计学意义(P>0.05)。结论微创穿刺术治疗高血压脑出血具有比传统开颅术更高的疗效,且简便易行、安全可靠,在临床上更具优势。

Clinical Comparative Study of Minimally Invasive Puncture Approach and Key Hole in the Evacuation of Hypertensive Cerebral Hematoma

Objective To compare the efficacy of minimally invasive puncture approach and key hole in the treatment of hypertensive cerebral hematoma.Methods According to the treatment indications and families advices,a total of 106 patients with hypertensive cerebral hematoma confirmed by CT were randomly divided into minimally invasive puncture approach group(minimally invasive group)and key hole evacuation of hematoma approach group(key hole group),53 patients each group.All patients were given key hole evacuation of hematoma or minimally invasive puncture treatment according to the admitted group,and the neurological function deficit score(NFDS)1,2 and 4 weeks after surgery of the two groups were compared,and the clinical efficacy was evaluated,then the fatality rate of the two groups were observed.Results 1 week after surgery,the NFDS scores of the two groups decreased than that of before surgery,but the difference was not statistically significant(P>0.05);2 weeks and 4 weeks after surgery,the NFDS scores further decreased(P<0.05),but the decreasing level of minimally invasive group was more obviously than that of the key hole group(P<0.05).The total effective rate of key hole group was statistically lower than that of minimally invasive group(P<0.05).No significant difference of fatality rate was observed between the two groups(P>0.05).Conclusion Minimally invasive puncture approach,which has the characteristics of easy operation,safe and reliable,is more effective than traditional craniotomy for hypertensive cerebral hematoma,thus is more advantageous in clinical.