發(fā)布時間：2018-12-10 20:05

【摘要】：研究背景:高血壓基底節(jié)區(qū)腦出血具有高發(fā)病率、高死亡率和高致殘率的特點,嚴重危害著患者的健康和生命。手術(shù)治療是高血壓基底節(jié)區(qū)腦出血重要的治療方法,然而許多研究表明,開顱手術(shù)治療并不一定能獲得優(yōu)于保守治療的療效。神經(jīng)內(nèi)鏡手術(shù)是應(yīng)用于高血壓基底節(jié)區(qū)腦出血的微創(chuàng)手術(shù)方法,但是其適用范圍和臨床療效尚未得到充分研究。研究方法:本研究收集了2012年5月到2014年5月就治于延安大學(xué)附屬醫(yī)院神經(jīng)外科內(nèi)鏡輔助下血腫清除手術(shù)治療高血壓基底節(jié)區(qū)腦出血(神經(jīng)內(nèi)鏡組)患者24例,并隨機選取了經(jīng)小骨窗開顱血腫清除手術(shù)治療高血壓基底節(jié)區(qū)腦出血(小骨窗組)患者50例進行對照研究。對比了兩組患者手術(shù)時間、術(shù)中出血量、血腫清除率、術(shù)后住院時間、死亡率、術(shù)后手術(shù)相關(guān)并發(fā)癥發(fā)生率、術(shù)后24小時格拉斯哥昏迷評分法(GCS)評分、術(shù)后1月和6月日常生活行為能力量表(ADL)評分。并按照患者年齡、出血量、腦室出血、術(shù)前改良愛丁堡-斯堪的納維亞評分(MESSS)以及術(shù)前GCS評分進行分組,分析各亞組兩種手術(shù)術(shù)后1月和6月ADL評分的差異。研究結(jié)果:兩手術(shù)組間性別構(gòu)成比、年齡、入院時收縮壓、出血量、出血部位、有無腦室出血、術(shù)前GCS評分以及術(shù)前MESSS評分均無顯著統(tǒng)計學(xué)差異(p0.05);相對于小骨窗組,神經(jīng)內(nèi)鏡組擁有更短的手術(shù)時間、更低的手術(shù)出血量、更高的血腫清除率以及更少的術(shù)后住院時間(p0.05);兩手術(shù)組間術(shù)后死亡率、手術(shù)相關(guān)并發(fā)癥發(fā)生率、術(shù)后24小時GCS評分增加無顯著差異(p0.05);對比不同亞組人群兩種手術(shù)術(shù)后1月及術(shù)后6月患者日常生活行為能力量表(ADL)評分發(fā)現(xiàn),神經(jīng)內(nèi)鏡手術(shù)在出血量為30-50ml、術(shù)前MESSS評分為16-30分,術(shù)前GCS評分≥9分的患者中,術(shù)后1月及術(shù)后6月平均ADL評分高于小骨窗開顱手術(shù)(p0.05)。結(jié)論:1.相對于小骨窗開顱減壓血腫清除手術(shù),內(nèi)鏡輔助下血腫清除手術(shù)治療高血壓基底節(jié)區(qū)腦出血手術(shù)時間短、手術(shù)出血量少、血腫清除率高、術(shù)后住院時間短;2.內(nèi)鏡輔助下血腫清除手術(shù)與小骨窗開顱血腫清除手術(shù)治療高血壓基底節(jié)區(qū)腦出血的術(shù)后手術(shù)相關(guān)并發(fā)癥發(fā)生率、死亡率以及術(shù)后早期療效無顯著差別;3.內(nèi)鏡輔助下血腫清除手術(shù)治療高血壓基底節(jié)區(qū)腦出血至少可以獲得與小骨窗開顱減壓血腫清除手術(shù)相當?shù)倪h期療效,在出血量為30-50ml、術(shù)前MESSS評分16-30分以及術(shù)前GCS評分≥9分的高血壓基底節(jié)區(qū)腦出血患者中,神經(jīng)內(nèi)鏡手術(shù)的遠期療效優(yōu)于小骨窗開顱手術(shù)。4.內(nèi)鏡輔助下血腫清除手術(shù)是高血壓基底節(jié)區(qū)腦出血安全有效的手術(shù)治療方法。
[Abstract]:Background: hypertensive basal ganglia intracerebral hemorrhage has the characteristics of high morbidity, high mortality and high disability rate, which seriously endangers the health and life of patients. Surgical treatment is an important treatment for hypertensive intracerebral hemorrhage in basal ganglia. However, many studies have shown that craniotomy is not always superior to conservative treatment. Endoscopic neurosurgery is a minimally invasive method for hypertensive basal ganglia hemorrhage, but its scope of application and clinical efficacy have not been fully studied. Methods: from May 2012 to May 2014, 24 patients with hypertensive basal ganglia intracerebral hemorrhage (endoscope group) were treated with endoscopic hematoma clearance under endoscopes in the affiliated hospital of Yan'an University. Fifty patients with hypertensive basal ganglia intracerebral hemorrhage (small bone window group) were selected randomly. The operative time, intraoperative bleeding volume, hematoma clearance rate, postoperative hospitalization time, mortality rate, postoperative complications, (GCS) score of Glasgow coma score at 24 hours after operation were compared between the two groups. One month and six months after operation, the (ADL) score of ADL was evaluated. The patients were divided according to age, bleeding volume, intraventricular hemorrhage, preoperative modified Edinburgh Scandinavia score (MESSS) and preoperative GCS score. The difference of ADL scores between the two subgroups was analyzed at 1 month and 6 months after operation. Results: there was no significant difference in sex composition, age, systolic blood pressure (SBP), bleeding volume, location of bleeding, ventricular hemorrhage, preoperative GCS score and preoperative MESSS score between the two groups (p0.05). Compared with the small bone window group, the neuroendoscopy group had shorter operation time, lower blood loss, higher hematoma clearance rate and less postoperative hospitalization time (p0.05). There was no significant difference between the two groups in the postoperative mortality, the incidence of operation-related complications and the increase of GCS score at 24 hours after operation (p0.05). Compared with the (ADL) score of ADL in patients with different subgroups after 1 month and 6 months after operation, it was found that the bleeding volume of neuroendoscopy was 30-50 ml, and the preoperative MESSS score was 16-30 points. In the patients with preoperative GCS score 鈮，

本文編號：2371127