不同手术方式对高血压脑出血患者术后并发症及疗效的影响

目的探讨不同手术方式对高血压脑出血患者术后并发症及临床疗效的影响。方法选取186例高血压脑出血患者为研究对象,随机分为大骨瓣组、小骨窗组、钻孔组各62例。大骨瓣组采用大骨瓣开颅术治疗,小骨窗组采用小骨窗开颅术治疗,钻孔组采用钻孔血肿抽吸引流术治疗。观察3组患者手术前与术后(2周)GCS评分和NIHSS评分及术后并发症和临床疗效。结果大骨瓣组术后GCS评分均低于其余2组(P0.05),大骨瓣组术后NIHSS评分均高于其余2组(P0.05);而小骨窗组与钻孔组术后GCS评分、NIHSS评分差异无统计学意义(P0.05)。3组术后再出血差异无统计学意义(P0.05),但大骨瓣组感染、应激性溃疡、肾衰竭发生率均高于其余2组(P0.05);同时,小骨窗组与钻孔组感染、肾衰竭发生率差异无统计学意义(P0.05),而小骨窗组应激性溃疡发生率高于钻孔组(P0.05)。大骨瓣组良好率为20.9%,小骨组窗48.4%,钻孔组50.0%,大骨瓣组与其余2组比较差异有统计学意义(χ~2=13.779,P=0.001);大骨瓣组病死率为25.8%,小骨窗组20.9%,钻孔组19.4%,大骨瓣组与其余2组比较差异无统计学意义(χ~2=0.687,P=0.709)。结论综合高血压脑出血患者不同手术术后并发症及临床疗效,钻孔血肿抽吸引流术优于小骨窗开颅术,小骨窗开颅术优于大骨瓣开颅术;但3种不同手术方式在病死率上无明显差异。

The influences of different surgical methods on postoperative complications and clinical efficacy in patients with hypertensive cerebral hemorrhage

Objective To explore the influences of different surgical methods on postoperative complications and clinical efficacy in patients with hypertensive cerebral hemorrhage (HCH ) .Methods All 186 cases with HCH were selected as re‐search subjects ,who were randomly divided into 3 groups ,62 cases in each group .Group A conducted large trauma craniotomy , group B employed small bone window craniotomy and group C received trepanation and hematoma aspiration .After two weeks we assessed the GCS and NIHSS scores ,postoperative complications and clinical curative efficacy between three groups .Results The group A showed less GCS scores and higher NIHSS scores than the other two groups (all P<0.05) ,however no statis‐tical differences were found between group B and group C as for GCS and NIHSS scores (P>0.05) .Although the three groups indicated no significant differences in terms of re-bleeding(P>0.05) ,the group A presented higher incidences of infection , stress ulcer and renal failure than others(P<0.05) ,and except for the incidence of stress ulcer when compared group B and group C(P<0.05) ,others did not showed statistical differences (P>0.05) .The good rate was 20.9% in group A ,48.4% in group B and 50.0% in group C which showed that group A held lower rate than others (P<0.05) .Mortality rate in three groups presented no difference that group A got 25.8% ,group B got 20.9% and group C got 19.4% (P>0.05) .Conclusion On the basis of the postoperative complications and clinical efficacy of different surgical methods ,we draw conclusions that trepanation and hematoma aspiration may be superior to small bone window craniotomy ,which takes an advantage over large trauma craniotomy but the mortality rate of the three methods may be not different .