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目的探讨微创颅内血肿清除术与小骨窗开颅血肿清除术治疗重症高血压脑出血患者的临床疗效。方法选取临汾市第四人民医院神经外科2012年5月—2016年2月收治的重症高血压脑出血患者63例,按照随机数字表法分为对照组(n=29)和观察组(n=34)。患者入院后均给予血常规、肝肾功能等实验室检查及相应的影像学检查,对照组患者采用小骨窗开颅血肿清除术,观察组患者采用微创颅内血肿清除术治疗。记录比较两组患者术前,术后1、3、7d的血肿量,并比较两组患者美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力及并发症发生情况。结果术前,两组患者血肿量比较,差异无统计学意义(P>0.05);术后1、3d时,观察组患者血肿量高于对照组(P<0.05);术后7d时,两组患者血肿量比较,差异无统计学意义(P>0.05)。术前,两组患者NIHSS评分比较,差异无统计学意义(P>0.05);术后,观察组患者NIHSS评分低于对照组(P<0.05)。观察组患者日常生活能力优于对照组(P<0.05)。观察组患者并发症发生率低于对照组(P<0.05)。结论微创颅内血肿清除术治疗重症高血压脑出血患者可有效清除血肿,改善神经功能缺损程度,提高日常生活能力,且安全性好。
Objective To investigate the clinical effect of minimally invasive intracranial hematoma and small craniotomy hematoma in the treatment of patients with severe hypertensive intracerebral hemorrhage. Methods Sixty-three patients with severe hypertensive intracerebral hemorrhage admitted to the Fourth People’s Hospital of Linfen City from May 2012 to February 2016 were randomly divided into control group (n = 29) and observation group (n = 34). All patients were given laboratory tests of blood, liver and kidney function and corresponding imaging examination after admission. Patients in the control group were treated with small bone window craniotomy and the observation group were treated with minimally invasive intracranial hematoma. The amount of hematoma in preoperative and postoperative 1, 3 and 7 days was recorded and compared. NIHSS score, daily living ability and complication were compared between the two groups. Results There was no significant difference in hematoma volume between the two groups before surgery (P> 0.05). At 1 and 3 days after operation, the hematoma volume in the observation group was significantly higher than that in the control group (P <0.05) Group hematoma volume comparison, the difference was not statistically significant (P> 0.05). There was no significant difference in NIHSS score between the two groups before operation (P> 0.05). After operation, the NIHSS score in the observation group was lower than that in the control group (P <0.05). The daily living ability of the observation group was better than that of the control group (P <0.05). The complication rate in observation group was lower than that in control group (P <0.05). Conclusion Minimally invasive intracranial hematoma in the treatment of patients with severe hypertensive intracerebral hemorrhage can effectively remove hematoma, improve the degree of neurological deficits and improve their daily living ability, and good safety.