發(fā)布時間：2018-01-29 12:10

  本文關鍵詞： 高血壓腦出血 神經內鏡 小骨窗開顱手術 療效　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本文通過比較神經內鏡微創(chuàng)手術與小骨窗開顱血腫清除手術治療高血壓幕上腦出血的多項臨床指標,分析兩種手術方式的療效,為臨床選擇合適的微創(chuàng)手術方式提供依據,提高患者的臨床療效,從而改善患者的預后。方法:本次研究嚴格按照所設計的病例納入及排除標準,對入選的56例臨床病例進行回顧性分析。按病例所接受的治療方法,將其分為神經內鏡組(A組)和小骨窗開顱組(B組)。首先對各組病例治療前狀況包括一般特征、術前意識狀態(tài)、出血量、手術時機、伴隨基礎疾病以及臨床神經功能缺失程度等進行評價,了解術前兩組的基本情況是否具有可比性。隨后對其手術時間、首次血腫清除率、術中出血量,住院期間的再出血發(fā)生率、死亡率、感染率、神經功能恢復程度以及住院時間進行比較。最后進行總體轉歸的比較,即手術后6個月療效對比分析。結果:(1)兩組病例的一般特征、術前意識狀態(tài)、出血量、手術時機、伴隨基礎疾病以及臨床神經功能缺失程度等,經統(tǒng)計檢驗,得出各組間差異均無統(tǒng)計學意義(P0.05)。(2)A組平均手術時間為(1.52±0.40)h,B組平均手術時間為(2.68±0.76)h,經統(tǒng)計學分析后,兩組結果存在差異(t=8.34,P0.01),即A組平均手術時間要小于B組。(3)A、B兩組在手術中平均失血量為分別為(35.61±13.52)ml和(277.14±101.33)ml,兩組間有統(tǒng)計學差異(t=7.84,P0.01)。(4)A、B兩組術后平均殘留血腫量分別為(5.31±7.15)ml、(10.48±8.67)ml,計算出血腫清除率分別為(90.12±4.32)%、(74.34±10.56)%,具有統(tǒng)計學差異(Z=4.38,P0.05)。(5)兩組患者平均住院時間(天)分別為(8.89±2.57)和(14.56±4.34),具有統(tǒng)計學意義(P0.05)。(6)在術后再出血率、死亡率、感染發(fā)生率方面,兩組均無統(tǒng)計學差異(P0.05)。(7)術前兩組神經功能缺損程度分值對比無統(tǒng)計學差異(P0.05);手術后第1周,A、B兩組神經功能缺損程度評分均低于手術前(P0.05);手術后第4周,A、B兩組評分均明顯低于手術前(P0.05);同期A、B兩組之間神經功能缺損程度比較中,手術后第1周差異有統(tǒng)計學意義(P0.05),第4周有統(tǒng)計學差異(P0.05),說明A組術后神經功能恢復速度要優(yōu)于B組。(8)術后6個月隨訪資料中,A組預后良好率(81.82%)高于B組良好率(65.63%)(P0.05)。結論:對于出血量30-50ml、病情較輕的幕上高血壓腦出血患者,神經內鏡微創(chuàng)手術較小骨窗開顱血腫清除術而言,是一種更具有微創(chuàng)、快捷、血腫清除率高、出血少、恢復快、預后好等優(yōu)點手術方法。
[Abstract]:Objective: to compare the clinical indexes of endoscopic minimally invasive surgery and small bone window craniotomy in the treatment of hypertensive supratentorial intracerebral hemorrhage. To provide the basis for clinical selection of appropriate minimally invasive surgery, improve the clinical efficacy of patients, and improve the prognosis of patients. Methods: this study strictly according to the designed case inclusion and exclusion criteria. A retrospective analysis of 56 clinical cases was carried out according to the treatment methods received by the patients. The patients were divided into neuroendoscopy group (group A) and small bone window craniotomy group (group B). With the basic diseases and the degree of clinical neurological deficit to evaluate, to understand whether the two groups before the basic conditions are comparable. Then the operation time, the first hematoma clearance rate, intraoperative blood loss. The incidence of rebleeding, mortality, infection rate, degree of neurological function recovery and length of stay during hospitalization were compared. Finally, the overall outcome was compared. Results the general characteristics of the two groups, preoperative consciousness, bleeding volume, surgical timing, associated basic diseases and the degree of clinical neurological deficit were compared and analyzed. The average operation time of group A was 1.52 鹵0.40 hours. The average operation time of group B was 2.68 鹵0.76 h. After statistical analysis, there was a difference between the two groups. The mean operative time of group A was less than that of group B (35.61 鹵13.52ml) and group B (277.14 鹵101.33ml). The mean blood loss was 35.61 鹵13.52ml in group A and 277.14 鹵101.33ml in group B, respectively. There was statistical difference between the two groups. The mean residual hematoma volume in the two groups was 5.31 鹵7.15ml. The hematoma clearance rates were calculated to be 90.12 鹵4.32 and 74.34 鹵10.56, respectively. The difference was statistically significant (P < 0.05). The average hospitalization time (days) was 8.89 鹵2.57 and 14.56 鹵4.34, respectively. There were significant differences in the rate of postoperative rebleeding, mortality and infection rate. There was no statistical difference between the two groups (P 0.05). There was no significant difference in the degree of nerve function defect between the two groups before operation (P 0.05). At the first week after operation, the scores of nerve function defect in group A and B were lower than those in group A (P 0.05) before operation. At the 4th week after operation, the scores of group A and B were significantly lower than those before operation (P 0.05). At the same time, there were significant differences in the degree of nerve function defect between the two groups at the first week after operation (P0.05), and at the 4th week (P0.05). The results showed that the recovery rate of nerve function in group A was better than that in group B (6 months). The good prognosis rate of group A (81.82) was higher than that of group B (65.63%). Conclusion: for patients with mild supratentorial hypertensive intracerebral hemorrhage, the bleeding volume is 30-50 ml. Endoscopic minimally invasive surgery is a more minimally invasive, rapid, high clearance rate, less bleeding, faster recovery and better prognosis than small bone window craniotomy.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.12;R544.1

【參考文獻】

相關期刊論文 前10條

1 印曉鴻;王遠傳;唐曉平;羅仁國;段R，

本文編號：1473382