小骨窗开颅行颅内血肿清除术治疗高血压脑出血的效果
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摘要
目的探讨小骨窗开颅行颅内血肿清除术治疗高血压脑出血的效果。方法选取2015年1月～2018年1月我院收治的80例高血压脑出血患者作为研究对象,按照随机数字表法将其分为对照组和观察组,每组各40例。对照组患者行大骨瓣开颅血肿清除术,观察组患者行小骨窗开颅行颅内血肿清除术。比较两组患者的手术相关指标(手术时长、住院时长、术中出血量、住院费用)、手术前后格拉斯哥昏迷量表(GCS)评分、术后3个月改良Barthel指数(MBI)评分及术后并发症发生情况。结果观察组患者的手术时长和住院时长均短于对照组,术中出血量少于对照组,住院费用低于对照组,差异有统计学意义(P<0.05)。两组患者术前的GCS评分比较,差异无统计学意义(P>0.05);两组患者术后的GCS评分均显著高于术前,差异有统计学意义(P<0.05);观察组患者术后的GCS评分及术后3个月的MBI评分均高于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率为12.50%,低于对照组的32.50%,差异有统计学意义(P<0.05)。结论小骨窗开颅行颅内血肿清除术的治疗效果确切,可缩短手术时长、住院时长,减少术中出血量和术后并发症,降低医疗费用,值得临床推广应用。
Objective To explore the clearance of hematoma by craniotomy with small bone window in the treatment of hypertensive cerebral hemorrhage.Methods A total of 80 patients with hypertensive cerebral hemorrhage from January2015 to January 2018 treated in our hospital were selected as research objects and they were divided into the observation group and the control group accroding to the random number table method,40 cases in each group.The control group was given the clearance of hematoma by craniotomy with big bone flap,and the observation group was given the clearance of hematoma by craniotomy with small bone window.Surgical related indicators(operation time,hospitalization time,intraoperative blood loss,hospitalization cost),Glasgow coma scale(GCS) score before and after surgery,modified Barthel index(MBI) score at 3 months after surgery and postoperative complications were compared between the two groups.Results The operation time and hospitalization time in the observation group were shorter than those in the control group,the intraoperative blood loss was less than that in the control group,the hospitalization cost was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the preoperative GCS score between the two groups(P>0.05).The GCS scores after surgery of the two groups were significantly higher than those before surgery,and the differences were statistically significant(P<0.05).The GCS scores of the patients after surgery and the MBI scores at the 3 months after surgery in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence rate of complications in the observation group was 12.50%,which was lower than that in the control group(32.50%),and the difference was statistically significant(P <0.05).Conclusion Clearance of hematoma by craniotomy with small bone window has definite curative effect,and it can shorten the operation time and hospitalization time,reduce the intraoperative hemorrhage and postoperative complications,reduce medical costs,which is worthy of clinical application.
Objective To explore the clearance of hematoma by craniotomy with small bone window in the treatment of hypertensive cerebral hemorrhage.Methods A total of 80 patients with hypertensive cerebral hemorrhage from January2015 to January 2018 treated in our hospital were selected as research objects and they were divided into the observation group and the control group accroding to the random number table method,40 cases in each group.The control group was given the clearance of hematoma by craniotomy with big bone flap,and the observation group was given the clearance of hematoma by craniotomy with small bone window.Surgical related indicators(operation time,hospitalization time,intraoperative blood loss,hospitalization cost),Glasgow coma scale(GCS) score before and after surgery,modified Barthel index(MBI) score at 3 months after surgery and postoperative complications were compared between the two groups.Results The operation time and hospitalization time in the observation group were shorter than those in the control group,the intraoperative blood loss was less than that in the control group,the hospitalization cost was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the preoperative GCS score between the two groups(P>0.05).The GCS scores after surgery of the two groups were significantly higher than those before surgery,and the differences were statistically significant(P<0.05).The GCS scores of the patients after surgery and the MBI scores at the 3 months after surgery in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence rate of complications in the observation group was 12.50%,which was lower than that in the control group(32.50%),and the difference was statistically significant(P <0.05).Conclusion Clearance of hematoma by craniotomy with small bone window has definite curative effect,and it can shorten the operation time and hospitalization time,reduce the intraoperative hemorrhage and postoperative complications,reduce medical costs,which is worthy of clinical application.
引文
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[16]陈唯实.微创钻孔引流术与小骨窗开颅术治疗中等量基底节区高血压脑出血的疗效比较[J].吉林医学,2015,36(7):1430-1431.
[17]周飞鹏,伍万里,李刚,等.小骨窗经额叶入路治疗高血压基底节区脑出血[J].中华神经外科疾病研究杂志,2015,14(2):178-180.
[18]余少雄,尹勇.小骨窗开颅与常规骨瓣开颅在高血压脑出血患者中的临床效果对比分析[J].中华临床医师杂志(电子版),2016,10(8):1108-1111.
[19]周维,杨立坚,李曦,等.神经节苷脂治疗微创颅内血肿清除术高血压脑出血的临床效果[J].中国医药导报,2017,14(5):79-82.
[2]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.
[3]吴鹏杰,刘伟,李胜利,等.高血压脑出血的外科治疗[J].中国微侵袭神经外科杂志,2015,20(4):164-165.
[4]叶富跃,杨堃,郑传宜,等.颅内微创血肿清除术与传统开颅清除血肿手术在高血压脑出血中的应用效果分析[J].河北医学,2016,22(1):17-20.
[5]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.
[6]中华医学会神经病学分会.中国脑出血诊治指南(2014).中华神经科杂志,2015,48(6):435-444.
[7]陈劲飞,肖化选,钟燕华.小骨窗微创脑出血清除术治疗高血压脑出血[J].吉林医学,2016,37(6):1365-1367.
[8]梁志坚.高血压脑出血CT影像与临床预后的相关性[J].实用临床医药杂志,2015,19(5):139-140.
[9]高彩燕,李恩有,聂焱,等.右美托咪定在高血压脑出血患者开颅手术中的临床应用[J].哈尔滨医科大学学报,2015,49(1):66-69.
[10]江思德,邹耀兵,唐明山,等.高血压脑出血早期控制血压对血肿扩大的影响[J].重庆医学,2015,44(23):3216-3217,3220.
[11]魏嘉良,董艳,侯立军.高血压脑出血微创手术治疗进展[J].第二军医大学学报,2015,36(12):1333-1338.
[12]曾冉,王飞红,袁邦清,等.高血压脑出血不同手术方式及手术时机的比较[J].广东医学,2016,37(3):393-396.
[13]姚晓辉,张世渊,成睿,等.神经导航及内镜下小骨窗治疗高血压脑出血[J].国际神经病学神经外科学杂志,2017,44(5):455-458.
[14]钱明,赵伟,蔡刚.小骨窗微创手术与开颅手术治疗高血压基底节脑出血的疗效比较[J].实用医学杂志,2015,31(23):3889-3891.
[15]张正平,李坤正,杨生龙.小骨窗显微手术治疗基底节区高血压脑出血的临床疗效[J].中国老年学杂志,2015,35(24):7116-7118.
[16]陈唯实.微创钻孔引流术与小骨窗开颅术治疗中等量基底节区高血压脑出血的疗效比较[J].吉林医学,2015,36(7):1430-1431.
[17]周飞鹏,伍万里,李刚,等.小骨窗经额叶入路治疗高血压基底节区脑出血[J].中华神经外科疾病研究杂志,2015,14(2):178-180.
[18]余少雄,尹勇.小骨窗开颅与常规骨瓣开颅在高血压脑出血患者中的临床效果对比分析[J].中华临床医师杂志(电子版),2016,10(8):1108-1111.
[19]周维,杨立坚,李曦,等.神经节苷脂治疗微创颅内血肿清除术高血压脑出血的临床效果[J].中国医药导报,2017,14(5):79-82.