小骨窗开颅血肿清除术与微创穿刺引流术治疗高血压脑出血疗效比较

目的比较小骨窗开颅血肿清除术与微创穿刺引流术治疗高血压脑出血(HICH)的临床疗效。方法选择1997年10月至2012年10月新疆哈密红星医院神经外科及北京大学第一医院神经外科收治的行手术治疗的HICH患者248例,其中131例行微创穿刺引流术(微创穿刺组),117例行小骨窗开颅血肿清除术(骨窗开颅组)。比较两组患者术后颅内感染、应激性溃疡、肺部感染、再出血、死亡的发生率,应用日常生活活动能力(ADL)分级对患者术后状态进行评估,比较两组患者的有效率。结果两组患者治疗后颅内感染、应激性溃疡、肺部感染、再出血及死亡的发生率比较差异均无统计学意义(P>0.05)。ADL分级显示:两组患者有效率比较差异无统计学意义(P>0.05)。结论小骨窗开颅血肿清除术与微创穿刺引流术在治疗HICH中同等有效,不仅能清除血肿、降低病死率、改善病后日常生活能力,而且对促进患者神经功能恢复有良好作用。

Comparative Research on Effectiveness between Hematoma Evacuation by Small Bone Window Craniotomy and Micro-Invasive Hematoma Aspiration in Treating Hypertensive Intracerebral Hemorrhage

Objective To compare the clinical effect between hematoma evacuation by small bone window craniotomy and micro-invasive hematoma aspiration in the treatment of hypertensive intracerebral hemorrhage（HICH）. Methods The data of 248 operating HICH cases admitted by Red Star Hospitalin Hami district of Xinjiang and Peking University First Hospital between Oct. 1997 and Oct. 2012 were included. 131 cases were operated with micro-invasive hematoma aspiration and 117 cases received hematoma evacuation by small bone window craniotomy. Postoperative rate of intracranial infection, stress ulcer, pulmonary infection, rebleeding and death of the two groups were analyzed. Postoperative status were evaluated by ADL scale and the effectiveness rate was compared. Results There was no significant difference in postoperative rate of intracranial infection, stress ulcer, pulmonary infection, rebleeding and death between the two groups （ P 〉 0.05）. There was also no significant difference in effectiveness rate between the two groups by ADL scale （ P 〉 0.05 ）. Conclusion Hematoma evacuation by small bone window craniotomy and micro-invasive hematoma aspiration are effective on the same level for the treatment of HICH, they can not only eliminate the hematoma, reduce the motality, improve the living status but also can promote the neural functional recovery.