神经导航及内镜下小骨窗治疗高血压脑出血疗效观察
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摘要
目的观察神经导航及内镜下小骨窗治疗高血压脑出血的疗效,为高血压脑出血的治疗方案选择提供依据。方法选择2017年1月至2018年10月期间南方医科大学深圳医院和深圳市人民医院神经外科收治的84例高血压脑出血患者为研究对象,根据入院日单双号原则将患者分为观察组和对照组,每组42例,对照组患者接受开颅手术治疗,观察组则接受神经导航及内镜下小骨窗治疗,比较两组患者的血肿清除情况以及并发症发生率,随访3个月,采用格拉斯哥预后评分(GOS)评价预后。结果观察组患者的残余血肿量和血肿清除率分别为(8.4±2.6) mL、(86.2±12.3)%,分别与对照组的(7.2±2.7) mL、(88.6±17.2)%比较差异均无统计学意义(P>0.05);观察组患者的肺部感染、再出血发生率分别为7.14%、2.38%,明显低于对照组的19.05%、11.90%,差异均有统计学意义(P<0.05);随访3个月,观察组患者的近期预后优良率为71.43%,明显高于对照组的50.00%,差异有统计学意义(P<0.05)。结论神经导航及内镜下小骨窗治疗高血压脑出血具有较好的血肿清除效果,同时可以降低术后并发症的发生风险,改善患者预后。
Objective To observe the efficacy of neuronavigation-assisted endoscopic small bone window in the treatment of hypertensive intracerebral hemorrhage(HICH), and to explore the effective treatment of HICH.Methods A total of 84 patients with HICH, who treated in Department of Neurosurgery of Shenzhen Hospital of Southern Medical University and Shenzhen People's Hospital from January 2017 to October 2018, were selected and divided into the observation group and control group according to the principle of single and double number on admission day, with 42 cases in each group. The patients in the control group were treated with craniotomy, while the patients in observation group were treated with neuronavigation-assisted endoscopic small bone window. The clearance of hematoma,and the incidence of complications were compared between the two groups. The Glasgow Prognosis Scale(GOS) was used to evaluate the prognosis after 3 months of follow-up. Results The amount of residual hematoma in the observation group was(8.4±2.6) mL versus(7.2±2.7) mL in the control group; the hematoma clearance rate in the observation group was(86.2 ±12.3)% versus(88.6±17.2)% in the control group(all P>0.05). the pulmonary infection rate and rebleeding in the observation group were 7.14% and 2.38%, respectively, which were significantly lower than corresponding 19.05% and 11.90% in the control group(all P<0.05). The excellent and good rate of short-term prognosis in the observation group was 71.43%, which was significantly higher than 50.00% in the control group(P<0.05).Conclusion Neuronavigation-assisted endoscopic small bone window is effective in the treatment of hypertensive intracerebral hemorrhage. It has good hematoma clearance effect, and can reduce the risk of postoperative complications and improve the prognosis of patients.
Objective To observe the efficacy of neuronavigation-assisted endoscopic small bone window in the treatment of hypertensive intracerebral hemorrhage(HICH), and to explore the effective treatment of HICH.Methods A total of 84 patients with HICH, who treated in Department of Neurosurgery of Shenzhen Hospital of Southern Medical University and Shenzhen People's Hospital from January 2017 to October 2018, were selected and divided into the observation group and control group according to the principle of single and double number on admission day, with 42 cases in each group. The patients in the control group were treated with craniotomy, while the patients in observation group were treated with neuronavigation-assisted endoscopic small bone window. The clearance of hematoma,and the incidence of complications were compared between the two groups. The Glasgow Prognosis Scale(GOS) was used to evaluate the prognosis after 3 months of follow-up. Results The amount of residual hematoma in the observation group was(8.4±2.6) mL versus(7.2±2.7) mL in the control group; the hematoma clearance rate in the observation group was(86.2 ±12.3)% versus(88.6±17.2)% in the control group(all P>0.05). the pulmonary infection rate and rebleeding in the observation group were 7.14% and 2.38%, respectively, which were significantly lower than corresponding 19.05% and 11.90% in the control group(all P<0.05). The excellent and good rate of short-term prognosis in the observation group was 71.43%, which was significantly higher than 50.00% in the control group(P<0.05).Conclusion Neuronavigation-assisted endoscopic small bone window is effective in the treatment of hypertensive intracerebral hemorrhage. It has good hematoma clearance effect, and can reduce the risk of postoperative complications and improve the prognosis of patients.
引文
[1]刘文斌.社区老年人高血压流行病学调查[J].中国全科医学, 2011,14(3):300-302.
[2]伏兵,王三敏,谭玉,等.早期强化降压治疗对高血压性脑出血患者脑血流动力学的影响[J].海南医学, 2014, 25(24):3603-3606.
[3]李建华,吴以艺,胡钜强.高血压脑出血个性化手术的疗效及对术后生活质量影响的研究[J].中国实用医药, 2016, 11(23):103-104.
[4]钱章林,郑勇,吴永刚,等.影响高血压脑出血微创治疗短期预后的相关因素分析[J].中华临床医师杂志(电子版), 2016, 10(7):919-925.
[5]李毅钊,钟志坚,孙海鹰,等.丘脑基底节区高血压脑出血的显微外科治疗及预后相关因素分析[J].国际神经病学神经外科学杂志,2016, 43(1):12-15.
[6]韩建立,胡分彩.高血压脑出血手术治疗时间的选择对患者疗效及生活质量的影响[J].现代中西医结合杂志, 2015, 24(1):85-86.
[7]董先成,郎清,陈忠,等.手术治疗高血压脑出血并脑疝患者的疗效及预后分析[J].中国实用神经疾病杂志, 2015, 18(15):25-26.
[8]余鹏飞,麦兴进,符树强.不同手术方式治疗高血压脑出血的疗效比较及复发影响因素分析[J].重庆医学, 2015, 44(13):1839-1841.
[9]沈阳,林少鹏,詹锡康.动态监测肿瘤坏死因子-α对高血压脑出血术后管理的临床意义[J].海南医学, 2017, 28(4):548-550.
[10] ZHANG J, LU S, WANG S, et al. Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage[J]. Pak J Med Sci, 2018, 34(3):578-582.
[11]侯前亮.高血压脑出血微创钻孔引流术75例治疗体会[J].中国实用神经疾病杂志, 2015, 18(12):101-101, 102.
[12]张福征,王才永,张磊,等.神经内镜与开颅手术治疗高血压脑出血的疗效比较[J].中华神经外科杂志, 2015, 31(1):19-21.
[13]颜玉峰,杜嘉瑞,沈晓,等.神经导航定向穿刺治疗高血压性基底节区脑出血疗效分析[J].复旦学报(医学版), 2016, 43(4):457-461.
[14]付伟,毕东祥,杜文彬,等.铁蛋白在高血压脑出血后血肿周围脑水肿中的作用及机制[J].中国医药导报, 2016, 13(2):46-49.
[15]孙奉辉,徐依成,陈新平,等.高血压脑出血血肿周围水肿与动态血压的相关性研究[J].中华老年心脑血管病杂志, 2016, 18(6):571-573.
[16]张钶,霍钢,王晓澍,等.早期强化降压对高血压脑出血患者颅内血肿及水肿的影响[J].第三军医大学学报, 2016, 38(7):757-760.
[2]伏兵,王三敏,谭玉,等.早期强化降压治疗对高血压性脑出血患者脑血流动力学的影响[J].海南医学, 2014, 25(24):3603-3606.
[3]李建华,吴以艺,胡钜强.高血压脑出血个性化手术的疗效及对术后生活质量影响的研究[J].中国实用医药, 2016, 11(23):103-104.
[4]钱章林,郑勇,吴永刚,等.影响高血压脑出血微创治疗短期预后的相关因素分析[J].中华临床医师杂志(电子版), 2016, 10(7):919-925.
[5]李毅钊,钟志坚,孙海鹰,等.丘脑基底节区高血压脑出血的显微外科治疗及预后相关因素分析[J].国际神经病学神经外科学杂志,2016, 43(1):12-15.
[6]韩建立,胡分彩.高血压脑出血手术治疗时间的选择对患者疗效及生活质量的影响[J].现代中西医结合杂志, 2015, 24(1):85-86.
[7]董先成,郎清,陈忠,等.手术治疗高血压脑出血并脑疝患者的疗效及预后分析[J].中国实用神经疾病杂志, 2015, 18(15):25-26.
[8]余鹏飞,麦兴进,符树强.不同手术方式治疗高血压脑出血的疗效比较及复发影响因素分析[J].重庆医学, 2015, 44(13):1839-1841.
[9]沈阳,林少鹏,詹锡康.动态监测肿瘤坏死因子-α对高血压脑出血术后管理的临床意义[J].海南医学, 2017, 28(4):548-550.
[10] ZHANG J, LU S, WANG S, et al. Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage[J]. Pak J Med Sci, 2018, 34(3):578-582.
[11]侯前亮.高血压脑出血微创钻孔引流术75例治疗体会[J].中国实用神经疾病杂志, 2015, 18(12):101-101, 102.
[12]张福征,王才永,张磊,等.神经内镜与开颅手术治疗高血压脑出血的疗效比较[J].中华神经外科杂志, 2015, 31(1):19-21.
[13]颜玉峰,杜嘉瑞,沈晓,等.神经导航定向穿刺治疗高血压性基底节区脑出血疗效分析[J].复旦学报(医学版), 2016, 43(4):457-461.
[14]付伟,毕东祥,杜文彬,等.铁蛋白在高血压脑出血后血肿周围脑水肿中的作用及机制[J].中国医药导报, 2016, 13(2):46-49.
[15]孙奉辉,徐依成,陈新平,等.高血压脑出血血肿周围水肿与动态血压的相关性研究[J].中华老年心脑血管病杂志, 2016, 18(6):571-573.
[16]张钶,霍钢,王晓澍,等.早期强化降压对高血压脑出血患者颅内血肿及水肿的影响[J].第三军医大学学报, 2016, 38(7):757-760.