小骨窗开颅内镜辅助血肿清除术治疗高血压脑出血的效果

林四仁

【摘要】 目的：探討分析小骨窗开颅内镜辅助血肿清除术治疗高血压脑出血的效果。方法：纳入2016年1月-2018年12月84例高血压脑出血患者，随机分为两组。对照组选择小骨窗开颅常规血肿清除术，神经内镜辅助组选择小骨窗开颅内镜辅助血肿清除术。分析手术操作时间、住院时间、手术出血量;治疗前后患者神经功能状态、格拉斯哥昏迷评分及生活自理状态;并发症。结果：治疗前两组神经功能状态、格拉斯哥昏迷评分及生活自理状态比较差异无统计学意义（P>0.05）;治疗后神经内镜辅助组各项指标均优于对照组，差异均有统计学意义（P<0.05）。神经内镜辅助组手术操作时间、住院时间、手术出血量均优于对照组，差异均有统计学意义（P<0.05）。神经内镜辅助组并发症发生率（7.14%）低于对照组（23.81%），差异有统计学意义（P<0.05）。结论：高血压脑出血患者实施小骨窗开颅内镜辅助血肿清除术可获得较好效果，可有效减少相关并发症的发生，缩短手术操作时间及住院时间，减少手术出血量，更好地改善患者的神经功能和意识状态，并提高患者的生活自理能力。

【关键词】 小骨窗开颅内镜 血肿清除术治疗 高血压脑出血 效果

doi：10.14033/j.cnki.cfmr.2019.28.023 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Effect of Small Bone Window Craniotomy-assisted Hematoma Evacuation on Hypertensive Intracerebral Hemorrhage/LIN Siren. //Chinese and Foreign Medical Research， 2019， 17（28）： 56-58

[Abstract] Objective： To investigate the effect of small bone window craniotomy-assisted hematoma evacuation in the treatment of hypertensive cerebral hemorrhage. Method： Eighty-four patients with hypertensive intracerebral hemorrhage were enrolled from January 2016 to December 2018， and they were randomly divided into two groups. In the control group， the routine hematoma evacuation was performed with small bone window craniotomy， and the neuroendoscopic auxiliary group was performed with the small endoscopic window. The operation time， the hospital stay， the operative blood loss， the neurological status of the patients before and after treatment， the Glasgow coma score， and the level of self-care status were analyzed. Result： There were no significant differences in neurological function， Glasgow coma score and self-care status between the two groups before treatment （P>0.05）. After treatment， the indexes of neuroendoscopic auxiliary group were better than those of control group， the differences were statistically significant （P<0.05）. The operation time， hospital stay and operative blood loss of the neuroendoscopic auxiliary group were better than those in the control group （P<0.05）. The incidence of complications in the neuroendoscopic auxiliary group （7.14%） was lower than that in the control group （23.81%）， the difference was statistically significant （P<0.05）. Conclusion： Patients with hypertensive intracerebral hemorrhage can achieve better results with small bone window craniotomy-assisted hematoma evacuation， which can effectively reduce the occurrence of related complications， shorten the operation time and the hospital stay time， and reduce the operative blood loss. It can better improve the patients neurological function and state of consciousness， and improve the patients ability to take care of themselves.

[Key words] Small bone window craniotomy Hematoma removal treatment Hypertensive cerebral hemorrhage Effect

First-authors address： Zhangpu County Hospital， Zhangpu 363200， China

高血压脑出血是病死率和致残率最高的疾病之一，主要是由于高血压和动脉硬化引起的脑血管病。目前，主要的临床治疗方法是保守治疗和手术治疗，手术治疗以幕上血肿>30 ml，幕下血肿>10 ml为指征，小骨窗开颅术可以有效清除血肿，但在视野外存在盲点，深部血肿难以清除。高血压脑出血患者的致残率高，死亡率高。早期治疗的关键是清除血肿。临床血肿清除术包括去骨瓣开颅术、微创钻孔引流术等，钻孔血肿清除一般不彻底，易再出血，易并发感染等，而开颅血肿清除具有完全清除血肿的一定优势，但创伤大，手术时间长，出血量多，术后水肿反应为重，神经功能加重，导致生活能力缺失，影响预后。随着医学水平的不断提高，神经内窥镜辅助小骨窗开颅术具有无明显视觉死角，血肿快速清除，创伤小，手术时间短等优点。近年来，……