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神经导航辅助下颅内血肿穿刺引流术与神经内镜血肿清除术治疗高血压脑出血的疗效比较。

Comparison of the efficacy of neuronavigation-assisted intracerebral hematoma puncture and drainage with neuroendoscopic hematoma removal in treatment of hypertensive cerebral hemorrhage.

机构信息

Department of Neurosurgery, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China.

出版信息

BMC Surg. 2024 Mar 12;24(1):86. doi: 10.1186/s12893-024-02378-3.

Abstract

OBJECTIVE

To compare neuronavigation-assisted intracerebral hematoma puncture and drainage with neuroendoscopic hematoma removal for treatment of hypertensive cerebral hemorrhage.

METHOD

Ninety-one patients with hypertensive cerebral hemorrhage admitted to our neurosurgery department from June 2022 to May 2023 were selected: 47 patients who underwent endoscopic hematoma removal with the aid of neuronavigation in observation Group A and 44 who underwent intracerebral hematoma puncture and drainage in control Group B. The duration of surgery, intraoperative bleeding, hematoma clearance rate, pre- and postoperative GCS score, National Institutes of Health Stroke Scale (NIHSS) score, mRS score and postoperative complications were compared between the two groups.

RESULTS

The duration of surgery, intraoperative bleeding and hematoma clearance were significantly lower in Group B than in Group A (p < 0.05). Conversely, no significant differences in the preoperative, 7-day postoperative, 14-day postoperative or 1-month postoperative GCS or NIHSS scores or the posthealing mRS score were observed between Groups A and B. However, the incidence of postoperative complications was significantly greater in Group B than in Group A (p < 0.05), with the most significant difference in incidence of intracranial infection (p < 0.05).

CONCLUSION

Both neuronavigation-assisted intracerebral hematoma puncture and drainage and neuroendoscopic hematoma removal are effective at improving the outcome of patients with hypertensive cerebral hemorrhage. The disadvantage of neuronavigation is that the incidence of complications is significantly greater than that of other methods; postoperative care and prevention of complications should be strengthened in clinical practice.

摘要

目的

比较神经导航辅助下颅内血肿穿刺引流术与神经内镜血肿清除术治疗高血压脑出血的效果。

方法

选取 2022 年 6 月至 2023 年 5 月我院神经外科收治的 91 例高血压脑出血患者,观察组 A 采用神经内镜下血肿清除术,观察组 B 采用神经导航辅助下颅内血肿穿刺引流术,对比两组患者的手术时间、术中出血量、血肿清除率、术前及术后 GCS 评分、美国国立卫生研究院卒中量表(NIHSS)评分、mRS 评分及术后并发症。

结果

观察组 B 的手术时间、术中出血量及血肿清除率均明显低于观察组 A(p<0.05);而两组患者术前、术后 7 天、术后 14 天及术后 1 个月的 GCS 评分、NIHSS 评分及术后恢复的 mRS 评分差异均无统计学意义(p>0.05)。但是观察组 B 的术后并发症发生率明显高于观察组 A(p<0.05),其中以颅内感染发生率的差异最显著(p<0.05)。

结论

神经导航辅助下颅内血肿穿刺引流术与神经内镜血肿清除术均能有效改善高血压脑出血患者的预后,神经导航的缺点是并发症发生率明显高于其他方法,在临床实践中应加强术后护理和并发症的预防。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/215a/10935852/d22c06ad127c/12893_2024_2378_Fig1_HTML.jpg

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