经颞部与经额部入路微创钻孔引流术治疗高血压脑出血的疗效观察

doi:10.3969/j.issn.1006-6233.2021.06.023

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摘要 目的: 研究经颞部与经额部入路微创钻孔引流术治疗高血压脑出血(HICH)的疗效。方法: 选择本院2016年2月至2020年2月诊治的106例左侧基底节区HICH患者作为研究对象,进行回顾性分析,根据手术的不同入路方式分为颞部组(48例,经颞部入路)和额部组(58例,经额部入路)。比较两组患者神经功能损伤情况、围术期指标以及日常生活功能,并统计术后并发症情况。结果: 额部组患者术后3d血肿残余量显著低于颞部组,差异具有统计学意义(P<0.05),其余指标两组比较比较均无统计学意义(P>0.05);两组患者NIHSS评分、CSS评分术后逐渐降低,组间以及时间的交互效应均有统计学意义(P<0.05);对各时间点比较,术后3、6个月额部组患者上述评分均显著低于颞部组,差异有统计学意义(P<0.05);两组患者日常生活功能评分术后逐渐升高,组间以及时间的交互效应均有统计学意义(P<0.05),对各时间点比较,术后3、6个月额部组患者上述评分均显著高于颞部组,差异有统计学意义(P<0.05),;两组患者术后颅内感染、肺部感染以及穿刺部位出血发生率无统计学意义(P>0.05)。结论: 经颞部和额部入路微创钻孔引流术均可安全有效的清除血肿,但经额部入路优势更佳,可在早期有效增加血肿清除量,促进日常生活和神经功能恢复。

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	刘光普

关键词 ：高血压脑出血, 颞部, 额部, 微创钻孔引流术, 左侧基底节区

Abstract：Objective: To study the curative effect of minimally invasive trepanation and drainage via the temporal approach and the frontal approach in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods: This study retrospectively reviewed 106 patients with HICH in left basal ganglia who were diagnosed and treated in the hospital between February 2016 and February 2020. They were divided into the temporal group (48 cases, temporal approach) and the frontal group (58 cases, frontal approach) according to the surgical approach. The two groups were compared with respect to nerve function impairment, perioperative indicators, and activity of daily living, and postoperative complications were counted. Results: The residual hematoma volume of the frontal group was significantly smaller than that of the temporal group at 3d after operation, and the difference was statistically significant (P<0.05), but no statistically significant differences were found in the other indexes (P>0.05). The NIHSS scores and CSS scores of the two groups gradually decreased after operation, and there were statistically significant differences in terms of inter-group effect and time effect (P<0.05). Comparison between different time points showed that the above scores of the frontal group at 3 and 6 months after operation were significantly lower than those of the temporal group, and the differences were statistically significant (P<0.05). The activity of daily living scores of the two groups gradually increased after operation, and there were statistically significant differences in terms of inter-group effect and time effect (P<0.05). Comparison between different time points showed that the above scores of the frontal group at 3 and 6 months after operation were significantly higher than those of the temporal group, and the differences were statistically significant (P<0.05). There were no statistically significant differences between the two groups in the incidences of intracranial infection, lung infection and puncture site bleeding (P>0.05). Conclusion: Minimally invasive trepanation and drainage through both the temporal approach and the frontal approach can safely and effectively remove the hematoma, but the latter has more advantages since it can effectively increase the removed hematoma volume in early stage, and promote recovery of activities of daily living as well as neurological function.

Key words： Hypertensive intracerebral hemorrhage Temporal approach Frontal approach Minimally invasive trepanation and drainage Left basal ganglia

基金资助:广东省梅州市科技计划项目,(编号:2018B001)

引用本文:

刘光普. 经颞部与经额部入路微创钻孔引流术治疗高血压脑出血的疗效观察[J]. 河北医学, 2021, 27(6): 990-994.
LIU Guangpu. An Observation of Curative Effect of Minimally Invasive Trepanation and Drainage Through the Temporal Approach and the Frontal Approach in the Treatment of Hypertensive Intracerebral Hemorrhage. HeBei Med, 2021, 27(6): 990-994.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.06.023 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I6/990

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