常规开颅与显微镜下微创手术治疗高血压脑出血的临床研究
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摘要
目的探讨常规开颅与显微镜下微创手术治疗高血压脑出血的疗效情况。方法随机选取我科2012年12月～2014年12月采用常规开颅手术治疗的高血压脑出血患者作为对照组,采用显微镜下微创手术治疗的患者作为观察组,每组30例,治疗后统计两组患者的血肿清除率、死亡率、临床疗效及日常生活能力评分(ADL)进行对比研究。结果两组患者血肿清除率差异无统计学意义(P> 0.05),观察组死亡率明显低于对照组(P <0.05);观察组总有效率为93.33%,明显高于对照组的70.00%;观察组日常生活能力总体恢复良好的比例为93.33%,明显高于对照组的66.67%,差异有统计学意义(P <0.05)。结论显微镜下微创手术治疗高血压脑出血相比于常规开颅手术更具有疗效,值得临床推广。
Objective To study and explore the curative effect of routine craniotomy and minimally invasive surgery under microscope in treatment of hypertensive cerebral hemorrhage. Methods Thirty patients with hypertensive cerebral hemorrhage who were treated with routine craniotomy in our hospital from December 2012 to December2014 were randomly selected as the control group.30 patients who were treated with minimally invasive surgery under microscope were selected as the observation group.The clearance rate of hematoma,mortality,clinical curative effect and activity of daily living(ADL)score were compared and studied between the two groups. Results There was no statistically significant difference in the clearance rate of hematoma between the two groups(P > 0.05).The mortality rate of the observation group was significantly lower than the control group(P < 0.05).The total effective rate of the observation group was 93.33%,which was significantly higher than the control group(70.00%).The overall recovery rate of daily living ability in the observation group was 93.33%,which was significantly higher than that in the control group(66.67%).The difference was statistically significant(P < 0.05). Conclusion Minimally invasive surgery under microscope in treatment of hypertensive cerebral hemorrhages more effective than routine craniotomy,which is worthy of clinical promotion.
Objective To study and explore the curative effect of routine craniotomy and minimally invasive surgery under microscope in treatment of hypertensive cerebral hemorrhage. Methods Thirty patients with hypertensive cerebral hemorrhage who were treated with routine craniotomy in our hospital from December 2012 to December2014 were randomly selected as the control group.30 patients who were treated with minimally invasive surgery under microscope were selected as the observation group.The clearance rate of hematoma,mortality,clinical curative effect and activity of daily living(ADL)score were compared and studied between the two groups. Results There was no statistically significant difference in the clearance rate of hematoma between the two groups(P > 0.05).The mortality rate of the observation group was significantly lower than the control group(P < 0.05).The total effective rate of the observation group was 93.33%,which was significantly higher than the control group(70.00%).The overall recovery rate of daily living ability in the observation group was 93.33%,which was significantly higher than that in the control group(66.67%).The difference was statistically significant(P < 0.05). Conclusion Minimally invasive surgery under microscope in treatment of hypertensive cerebral hemorrhages more effective than routine craniotomy,which is worthy of clinical promotion.
引文
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[10]朱长琪,孟令毅,杨静,等.随机血糖和乳酸脱氢酶水平在急性高血压脑出血患者预后评价中的意义[J].重庆医学,2015,44(23):3242-3244.
[11]王银玲,徐文婷,林马飞,等.老年重症高血压性脑出血患者辅助应用颅内压监测对二次伤害的预防价值[J].中国老年学杂志,2018,38(13):3095-3097.
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[13]申岳林,童运梅,雷兰芳,等.微创钻孔引流位置不同对基底节区高血压性脑出血患者血肿清除量、生活质量及并发症发生风险的影响[J].国际神经病学神经外科学杂志,2016,43(6):536-539.
[14]郑鲲,谭娟,冯辉斌,等.微创穿刺引流联合开颅血肿清除术对高血压脑出血合并脑疝患者预后的影响[J].山东医药,2015,55(30):74-75.
[15]管静静,赵冠安,张学磊,等.银杏达莫注射液用于高血压脑出血微创术后神经功能恢复的临床观察[J].中国药房,2015,26(32):4526-4528.
[16]葛新,陈晓雷,孙吉庆,等.神经内镜微创手术与开颅血肿清除术治疗高血压脑出血疗效比较[J].中国神经精神疾病杂志,2016,42(10):605-608.
[2]王兴铧,杜嘉庚.幕上高血压脑出血不同治疗方法效果分析[J].中国急救医学,2016,36(12):1103-1106.
[3]陆黎春,郁明惠,李伟生,等.不同部位高血压脑出血术式和时机选择及其对患者术后GOS和ADL分级的影响[J].中国老年学杂志,2018,38(8):1874-1877.
[4]符黄德,黄海能,邓元央,等.老年高血压急性脑出血患者炎症因子水平与周围脑组织水肿的相关性[J].中国老年学杂志,2017,37(12):2924-2926.
[5]刘勇,王萍,赵希敏,等.右美托咪定与咪达唑仑治疗高血压脑出血的镇静效果比较[J].实用医学杂志,2016,32(8):1322-1324.
[6]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.
[7]中华神经科学会,中华神经外科学会.全国第四届脑血管病学术会议:脑卒中临床疗效评定标准[J].中华神经外科杂志,1996,29(6):387-390.
[8]刘卫东.高血压性脑出血的诊治进展[J].上海医学,2017,40(11):646-649.
[9]戴志强,张旋,冯阳,等.高盐诱导自发性高血压大鼠脑出血及脑微血管构筑改变[J].第三军医大学学报,2016,38(21):2291-2296.
[10]朱长琪,孟令毅,杨静,等.随机血糖和乳酸脱氢酶水平在急性高血压脑出血患者预后评价中的意义[J].重庆医学,2015,44(23):3242-3244.
[11]王银玲,徐文婷,林马飞,等.老年重症高血压性脑出血患者辅助应用颅内压监测对二次伤害的预防价值[J].中国老年学杂志,2018,38(13):3095-3097.
[12]连晓东,林麒.高血压并发脑出血尼卡地平治疗期间血钙和血肌酐水平的变化及意义[J].广东医学,2016,37(17):2660-2663.
[13]申岳林,童运梅,雷兰芳,等.微创钻孔引流位置不同对基底节区高血压性脑出血患者血肿清除量、生活质量及并发症发生风险的影响[J].国际神经病学神经外科学杂志,2016,43(6):536-539.
[14]郑鲲,谭娟,冯辉斌,等.微创穿刺引流联合开颅血肿清除术对高血压脑出血合并脑疝患者预后的影响[J].山东医药,2015,55(30):74-75.
[15]管静静,赵冠安,张学磊,等.银杏达莫注射液用于高血压脑出血微创术后神经功能恢复的临床观察[J].中国药房,2015,26(32):4526-4528.
[16]葛新,陈晓雷,孙吉庆,等.神经内镜微创手术与开颅血肿清除术治疗高血压脑出血疗效比较[J].中国神经精神疾病杂志,2016,42(10):605-608.