精准微创显微手术治疗高血压脑出血临床观察

目的观察精准微创显微手术治疗高血压脑出血的临床疗效。方法回顾我科2012-06—2015-08收治的资料完整的高血压脑出血患者76例,40例采用精准微创显微手术颅内血肿清除术为观察组,36例采用经典的大骨瓣颅内血肿清除+去骨瓣减压术为对照组。比较2组手术操作时间、术后住院时间、术后不良反应及并发症。比较术后1周2组神经功能缺损评分(NIHSS)及影像学检查;术后随访3个月,观察2组日常生活能力(ADL)评分。结果观察组术后神经功能缺损评分显著优于对照组;观察组手术操作时间(102.87±7.99)min及术后住院时间(11.2±1.4)d,均明显短于对照组的(141.86±9.06)min及(15.2±1.1)d(P0.05);术后血肿残留、皮下血肿、肺部感染等并发症发生率(12.5%、2.5%、45%)低于对照组(22.2%、8.3%、55.6%)。结论精准微创显微手术治疗高血压脑出血在规范化治疗的基础上追求个体化、微创化、精准化、保护功能的发展趋势,值得推广和实践。

Clinical observation of precise minimal-invasion microsurgery in the treatment of hypertensive cerebral hemorrhage

Objective To observe the clinical efficacy of precise minimal-invasion microsurgery(MIS) in the treatment of hypertensive cerebral hemorrhage(HCH).Methods Completely clinical data of 76 HCH cases from June 2012 to August 2015 were retrospective analyzed.All patients were randomly divided into observation group(40 cases) and control group(36 cases).Patients in the observation group were treated by precise MIS,while patients in the control group received traditional method of large trauma craniotomy for removing intracranial hematoma and decompressive craniotomy.The operation time,postoperative hospital stay,postoperative adverse reactions and complications were compared between the two groups.Neurological deficit scores(NIHSS) and imaging examinations were compared one week after surgery.The ADL(activity of daily life) scores of the two groups were observed after three-month follow-up.Results Observation group showed better NIHSS scores than control group.The operation time and postoperative hospital stays in the observation group were(102.87±7.99)min and(11.2±1.4)d,significantly shorter than(141.86±9.06)min and(15.2±1.1)d in the control group(P<0.05).Complication rates of residual hematoma,postoperative subcutaneous hematoma and pulmonary infection(12.5%,2.5%,45%,respectively) were statistically lower than those in the control group(22.2%,8.3%,55.6%,respectively).Conclusion Precise MIS may take individualization,minimal invasion,precision and protection into account at the basis of standardized treatment,which should be extensively promoted and applied.