微侵袭血肿清除术对高血压脑出血患者术后神经功能恢复及并发症的影响

目的 分析微侵袭血肿清除术对高血压脑出血患者术后神经功能恢复及并发症的影响。方法 选取2017年6月至2020年5月期间我院38例高血压脑出血患者,按照手术方式不同将患者分为微侵袭组（n=12）和大骨瓣组（n=26）。微侵袭组给予微侵袭血肿清除术治疗;大骨瓣组采用基底节区改良翼点入路,骨窗大小约为6 cm×8 cm。比较两组患者临床疗效、手术情况、临床神经功能缺失量表（NDS）评分、日常生活能力量表（ADL）评分以及并发症发生情况。结果 微侵袭组患者总好转率为91.67%,高于大骨瓣组的73.07%,差异无统计学意义（P>0.05）;微侵袭组手术时间、术中出血量明显小于大骨瓣组（P<0.05）,两组血肿清除率、住院时间比较无明显差异（P>0.05）;手术后3个月,两组患者NDS评分均明显低于本组手术前（P<0.05）,ADL评分均明显高于本组手术前（P<0.05）,微侵袭组患者NDS评分明显低于大骨瓣组（P<0.05）,ADL评分明显高于大骨瓣组（P<0.05）;两组患者颅内感染、肺部感染以及再出血并发症总发生率对比无统计学差异（P>0.05）。结论 与传统大骨瓣开颅术相比,微侵袭血肿清除术治疗高血压脑出血更加安全有效,患者术后神经功能恢复更好,并发症更少。

Effects of minimal invasive surgery treatment on postoperative neurological function recovery and complications in patients with hypertensive intracerebral hemorrhage

Objective To analyze the effects of minimal invasive hematoma removal on postoperative neurological function recovery and complications in patients with hypertensive intracerebral hemorrhage. Methods From June 2017 to May 2020, 38 patients with hypertensive intracerebral hemorrhage in our hospital were selected and divided into craniotomy group （n=26） and minimal invasive group （n=12） according to different surgical methods. Minimal invasive group was given microinvasive hematoma removal, and craniotomy group was given an approximately 6 cm×8 cm bone window craniotomy. The clinical efficacy, surgical status, clinical neurological deficit scale （NDS） score and ability of daily living scale （ADL） score and the occurrence of complications were compared between the two groups. Results The total improvement rate of patients in minimal invasive group was higher than that in craniotomy group （91.67% vs. 73.07%） （P>0.05）. The operative time and intraoperative blood loss in minimal invasive group were significantly less than those in craniotomy group （P<0.05）. There was no significant difference in the hospital stay and hematoma clearance rate between the two groups （P>0.05）. At 3 months after surgery, the NDS scores in the two groups were significantly lower than those in the same group before surgery （P<0.05）, and the ADL scores were significantly higher than those in the same group before surgery （P<0.05）. The NDS score in minimal invasive group was significantly lower than that in craniotomy group （P<0.05） while the ADL score was significantly higher than that in craniotomy group （P<0.05）. The total incidence rate of complications such as intracranial infection, pulmonary infection and rebleeding between two groups had no significance （P<0.05）. Conclusion Compared with craniotomy group, minimal invasive surgery treatment is safer and more effective in treating hypertensive intracerebral hemorrhage, and it has better recovery of postoperative neurological function and fewer complications.