小骨窗血肿清除术与微创穿刺术治疗高血压脑出血的对照研究

目的比较小骨窗血肿清除术与微创穿刺术治疗高血压脑出血的疗效。方法将98例经CT确诊的高血压脑出血患者按照随机数字法分为小骨窗血肿清除术组和微创穿刺术组,每组各49例。分别根据入组情况行小骨窗血肿清除术或微创穿刺术,于治疗结束后1、2、4周进行神经功能缺损程度评分,并进行临床疗效评价,观察手术治疗的病死率及术后再出血情况。结果术后1周,两组患者神经功能缺损程度评分均减少,但与术前比较,差异无统计学意义（P〉0.05）;术后2周及4周,两组神经功能缺损程度评分进一步减少,与术前比较,差异有统计学意义（P〈0.05或P〈0.01）,微创穿刺术组神经功能缺损程度评分减少较小骨窗血肿清除术组更明显（P〈0.05或P〈0.01）。小骨窗血肿清除术组术后总有效率显著低于微创穿刺术组（χ2=3.78,P〈0.05）。微创穿刺术组病死率2.04%（1/49）]与小骨窗血肿清除术组4.08%（2/49）]比较,差异无统计学意义（χ2=1.50,P〉0.05）。微创穿刺术组术后再出血发生率为4.08%（2/49）,显著低于小骨窗血肿清除术组的16.33%（8/49）（χ2=2.84,P〈0.05）。结论微创穿刺术治疗高血压脑出血创伤小,疗效好,患者意识恢复快,安全性高,可在临床推广应用。

Comparative study of key hole and minimally invasive puncture approach in the treatment of hypertensive cerebral hematoma

Objective To compare the efficacy of key hole and minimally invasive puncture approach in the treatment of hypertensive cerebral hematoma.Methods A total of 98 patients with hypertensive cerebral hematoma who were confirmed by CT were randomly divided into key hole evacuation of hematoma approach group(key hole group) and minimally invasive puncture approach group(minimally invasive group),each group had 49 patients.All patients were given key hole evacuation of hematoma or minimally invasive puncture treatment according to the admitted group,and the neurological function deficit score(NFDS) 1,2 and 4 weeks after surgery of the two groups were compared,and the clinical efficacy was evaluated,then the fatality rate and the incidence postoperative re-haemorrhagia of the two groups were observed.Results 1 week after surgery,the NFDS scores of the two groups decreased than that of before surgery,but the difference was not statistically significant(P>0.05);2 weeks and 4 weeks after surgery,the NFDS scores furtherly decreased(P<0.05 or P<0.01),but the decreasing level of minimally invasive group was more obviously than that of the key hole group(P<0.05,P<0.01).The total effective rate of key hole group was statistically lower than that of minimally invasive group(χ2=3.78,P<0.05).No significant difference of fatality rate was observed between the two groups 2.04%(1/49) vs 4.08%(2/49),χ2=1.50,P>0.05].The incidence of postoperative re-haemorrhagia of minimally invasive group was obviously lower than that of key hole group 4.08%(2/49) vs 16.33%(8/49),χ2=2.84,P<0.05].Conclusion Minimally invasive puncture approach has the characteristics of small injury,good efficacy,rapid recovery of consciousness and high safety in the treatment of hypertensive cerebral hematoma,thus it can be extensively applied in clinic.