摘要
目的探讨神经内镜下小骨窗血肿清除术(SWC)与微创软通道血肿清除术治疗高血压脑出血(HICH)的疗效和体会。方法选择南通市第四人民医院神经外科2017年1月—2020年12月收治的高血压脑出血患者70例随机分为两组,观察组采用神经内镜下SWC,对照组采用微创软通道引流术,观察两组手术、临床和疗效等指标。结果观察组的手术时间为(53.26±9.18)min、出血量为(34.52±6.83)mL,高于对照组的(32.90±5.47)min和(21.38±4.55)mL,差异有统计学意义(t=11.272、9.472,P<0.05);观察组的甘露醇用量为(226.97±45.61)mL,术后颅内压为(19.92±2.16)mmHg,均低于对照组的(313.26±58.09)mL和(22.15±2.87)mmHg,差异有统计学意义(t=6.912、4.148,P<0.05)。术后1周时观察组的血清超敏C-反应蛋白(hs-CRP)和肿瘤坏死因子α(TNF-α)水平为(7.39±1.76)mg/mL和(43.59±5.18)pg/mL,高于对照组的(6.48±1.59)mg/mL和(37.43±4.86)pg/mL,差异有统计学意义(t=5.547、8.964,P<0.05);两组的美国国立卫生研究院卒中量表(NIHSS)和日常生活能力(BI)评分均较前显著改善,差异有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。观察组的血肿残留率和再出血率均分别为0.00%和2.86%,低于对照组的17.14%和22.86%,差异有统计学意义(χ^(2)=4.557、4.590,P<0.05);两组的并发症率和围术期病死率比较,差异无统计学意义(P>0.05)。结论神经内镜下SWC和微创软通道治疗HICH均具有较好的疗效,微创软通道的创伤较轻,小骨窗开颅术的血肿清除率和疗效更佳,可优先考虑选用。
Objective To investigate the efficacy and experience of neuroendoscopic small bone window hematoma removal(SWC)and minimally invasive soft channel hematoma removal in the treatment of hypertensive cerebral hemorrhage(HICH).Methods Seventy patients with hypertensive cerebral hemorrhage admitted to the Department of Neurosurgery of Nantong Fourth People's Hospital from January 2017 to December 2020 were randomly divided into two groups.The observation group was treated with SWC under neuroendoscopy,and the control group was treated with minimally invasive soft channel drainage.The two groups were observed for surgery,clinical and efficacy indicators.Results The operation time and blood loss in the observation group were(53.26±9.18)min and(34.52±6.83)mL,which were higher than those in the control group(32.90±5.47)min and(21.38±4.55)mL,the difference was statistically significant(t=11.272,9.472,P<0.05).The amount of mannitol in the observation group was(226.97±45.61)mL,and the postoperative intracranial pressure was(19.92±2.16)mmHg,both lower than that in the control group(313.26±58.09)mL and(22.15±2.87)mmHg,and the differences were statistically significant(t=6.912,4.148,P<0.05).The serum hS-CRP and TNF-αlevels of the observation group were(7.39±1.76)mg/mL and(43.59±5.18)pg/mL one week after operation,significantly higher than that of control group(6.48±1.59)mg/mL and(37.43±4.86)pg/mL,the difference was statistically significant(t=5.547,8.964,P<0.05).National Institutes of health stroke scale(NIHSS)and daily living ability(BI)scores were significantly improved in both groups(P<0.05),but there was no statistical significance between groups(P>0.05).The hematoma residual rate and rebleeding rate in the observation group were 0.00%and 2.86%,respectively,lower than 17.14%and 22.86%in the control group,the difference was statistically significant(χ^(2)=4.557,4.590,P<0.05).There were no significant differences in complication rate and perioperative mortality between the two groups(P>0.05).Conclusion Both smal
作者
朱蔚骏
成静
陈普进
徐健
ZHU Weijun;CHENG Jing;CHEN Pujin;XU Jian(Department of Neurosurgery,the Fourth People's Hospital of Nantong,Nantong,Jiangsu Province,226002 China)
出处
《世界复合医学》
2021年第10期18-22,共5页
World Journal of Complex Medicine
基金
南通市科技局关键技术研究-农业与社会发展-新型临床诊疗技术攻关项目(GJZ17098)。
