显微镜下小骨窗开颅手术治疗高血压脑出血的疗效及对患者近期预后和生活质量的影响

目的 探讨小骨窗开颅显微手术治疗高血压脑出血的疗效及其对患者近期预后和生活质量的影响.方法 回顾性分析2016年2月至2020年2月阜南县人民医院神经外科收治的86例高血压脑出血患者临床资料,将常规骨窗开颅手术进行治疗的40例患者列为对照组,将显微镜下小骨窗开颅手术进行治疗的46例患者列为研究组,比较两组治疗总有效率,术前和术后28天的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(MRS)评分、日常生活活动能力巴氏指数(BI)评分及长谷川痴呆量表(HDS)评分;记录两组术后28天的不良反应(食欲减退、胃肠反应、皮疹)情况.结果 研究组治疗总有效率(P=0.009)高于对照组,不良反应发生率(P=0.002)低于对照组,差异均有统计学意义(P<0.05).治疗前,两组NIHSS、MRS、BI及HDS评分比较,差异无统计学意义(P>0.05),研究组NIHSS、MRS评分治疗前后降幅高于对照组(t=33.630、7.819),BI、HDS评分治疗前后升幅高于对照组(t=26.190、27.000),差异均有统计学意义(P<0.05).结论 高血压脑出血患者采用显微镜下小骨窗开颅手术进行治疗,疗效尚可,安全性更高,可助益患者近期预后和生活质量的提高.

Effect of small bone window craniotomy under microscope on hypertensive intracerebral hemorrhage and its effect on short-term prognosis and quality of life of patients

Objective To investigate the effect of microsurgery with small bone window in the treatment of hypertensive intracerebral hemorrhage and its effect on short-term prognosis and quality of life of patients. Methods The clinical data of 86 patients with hypertensive intracerebral hemorrhage admitted to the Neurosurgery Department of Funan County People''s Hospital from February 2016 to February 2020 were retrospectively analyzed. 40 patients treated by conventional bone window craniotomy were included in the control group, and 46 patients treated by small bone window craniotomy under microscope were included in the study group. The total response rate, the National Institutes of Health Stroke Scale (NIHSS) scores, the modified Rankin Scale (MRS) scores, the Barnett Index (BI) scores of the activities of daily living and the Nagatagawa Dementia Scale (HDS) scores were compared between the two groups before and 28 days after surgery. Results The total effective rate of the study group (P=0.009) was higher than that of the control group, and the incidence of adverse reactions (P=0.002) was lower than that of the control group, both with statistical significance (P<0.05). Before treatment, there was no significant difference in NIHSS, MRS scores, BI scores and HDS scores between the two groups (P>0.05). The decreases of NIHSS and MRS scores in the study group before and after treatment were higher than those in the control group (t=33.630, 7.819). BI and HDS scores increased more before and after treatment than those in the control group (t=26.190, 27.000), with statistical significance (P<0.05). Conclusions The application of small bone window craniotomy under microscope in treatment of patients with hypertensive intracerebral hemorrhage has reasonable efficacy and higher safety, which can help improve the patients'' short-term prognosis and quality of life.