锥颅引流术与小骨窗开颅显微手术治疗高血压基底节区脑出血的疗效比较

目的比较锥颅引流术与小骨窗开颅显微手术治疗高血压基底节区脑出血(hypertensive basal ganglia hemorrhage,HBGH)的临床疗效。方法选取2013-01—2014-01我院收治的100例HBGH患者为研究对象,按随机数表法将其分为对照组和观察组各50例。对照组采取锥颅引流术治疗,观察组采取小骨窗开颅显微手术治疗。比较2组患者手术的一般情况及术后血肿清除率、复发率、病死率及并发症发生率,术后随访3个月,记录术后的神经功能缺损评分及日常生活活动能力(ADL)分级情况,并进行比较。结果与对照组相比,观察组手术时间及住院时间均较短,手术失血量较少,差异具有统计学意义(P0.05);观察组血肿清除率(90%)为70.0%,明显高于对照组(P0.05),而复发率、病死率与对照组比较差异无统计学意义(P0.05);观察组术后的并发症发生率为12.0%,明显低于对照组(P0.05);与术前神经功能缺损评分相比,术后2组患者的神经功能缺损评分均呈不断下降趋势,且观察组下降更为显著(P0.05);观察组患者术后日常生活能力恢复良好率(ADLⅠ级~Ⅲ级)为88.0%,明显高于对照组(P0.05)。结论与锥颅引流术相比,HBGH患者采取小骨窗开颅显微镜手术治疗后的血肿清除效率更高,神经功能恢复情况更好,预后更佳,值临床推广。

Comparison of curative effect of skulldrilling and small bone window craniotomy in the treatment of hyperten-sive intracerebral hemorrhage in basal ganglia

Objective To compare the clinical effects of skull drilling and small bone window craniotomy in the treat‐ment of hypertensive intracerebral hemorrhage in basal ganglia(HBGH) .Methods One hundred cases with HBGH in our hos‐pital from January 2013 to January 2014 were selected and divided into control group and observation group according to ran‐dom number table method ,50 cases in each group .The control group received skull drilling treatment while the observation group received small bone window craniotomy .Then general status ,clearance rate of hematoma ,recurrent rate ,mortality and occurrence rate of complications in two groups were compared and the neurological functional deficit scores (NIHSS) and activi‐ties of daily living (ADL ) were recorded during the three-month followed-up periods .Results Compared with the control group ,the observation group showed shorter operation time and hospitalization stays and less blood loss ,with statistically sig‐nificant differences(P<0.05) .The clearance rate of hematoma in the observation group were 70.0% ,significantly higher than that in the control group(P<0.05) ,however ,recurrent rate and mortality between two groups showed no statistical differ‐ences(P>0.05) .The observation group had the lower occurrence rate of complications (12% ) than control group(P<0.05) . After operation ,the NIHSS scores were significantly reduced in both two groups ,especially in the observation group ( P<0.05) .The favorable rate of ADL (Ⅰ level to Ⅲ level) was 88.0% in observation group ,obviously higher than that in control group(P<0.05) .Conclusion Compared with skull drilling ,small bone window craniotomy can more effectively remove hema‐toma ,can improve neurological function better and show better prognosis in HBGH patients ,which should be popularized in clinical practice .