| Objectives:To explore the curative effect and safety difference between minimally invasive hematoma aspiration and craniotomy and craniotomy in the treatment of hypertensive intracerebral hemorrhage,and provide more basis for the choice of clinical treatment.Methods:The clinical data of 129 patients with acute cerebral hemorrhage treated in our hospital in August-2017 to January 2015 were analyzed retrospectively.According to the different surgical methods,the patients were divided into craniotomy group and minimally invasive hematoma puncture aspiration group,including 59 cases in craniotomy group and 70 cases of minimally invasive hematoma aspiration and aspiration group.All cases were included in the standard:All of them were confirmed by brain CT or MRI imaging,and had a history of hypertension,with hemorrhage on the screen,and the amount of hematoma of 30ml was less than or equal to 60ml.Case exclusion criteria:other causes of cerebral hemorrhage,previous history of stroke,coagulation dysfunction,important organs such as liver and kidney dysfunction and clinical data were excluded..The craniotomy operation group,namely the general anesthesia tracheal intubation under the CT scan to confirm the hematoma position,Straight incised small bone window craniotomy or standard bone flap,the microscope to clear hematoma,effective hemostasis after the residual cavity drainage tube;Puncture drainage group of patients with hematoma puncture drainage,namely according to CT scan confirmed the hematoma location,local anesthesia downlink skull drilling pipe,pay attention to avoid the brain functional areas and important blood vessels,hematoma suction cavity drainage tube placement,such as suction meet resistance,stop,avoid forced smoke draw up bleeding is aggravating,sterile drainage device connection,2h hematoma intravasation after the operation of urokinase 3-4 U,2 times a day,after the residual hematoma is lower than10ml after extraction Drainage tube.Compared the general data of two groups of patients,such as sex,age and hematoma,compared the loss of nerve function in the two groups before operation,using NIHSS score,followed up for 6 months,and recorded the operation time,the first hematoma clearance,the number of postoperative rebleeding,the post operation instant,24h and 5d intracranial pressure level,and compared the average hospitalization of the two groups.A modified mRS scale was used to evaluate the prognosis of nerve function recovery.The quality of life was evaluated with ADL-BI scale,the number of death cases and the percentage of calculation were recorded.This study used Epidata3.02 to complete the double entry of data and completed the logic error correction and weight checking,and calculated the arithmetic average of each index on this basis.Standard deviation;statistical analysis was carried out with SPSS22.0 software.The measurement data were expressed in the form of(mean standard deviation),t-test was used;the count data were tested byχ~2 test;the test level was 0.05,and P<0.05 was statistically significant.Results:1.The comparison of general data between 2 groupsIn the craniotomy group,there were 34 male and 25 female,with the average age of(51.59±11.61)years.According to the bleeding position,41 cases of basal ganglia,10cases of thalamus,8 cases of cerebral lobes,17 cases broken into the ventricle,<40ml 18cases,40-50ml 26 cases,>50ml 15 cases,according to the onset to operation time,<6h25cases,6-72h 30cases,>72h 4cases.In the minimally invasive operation group,41 cases were male and 29 cases female,with the average age was(50.19±12.27)years.According to the bleeding position,47 cases of basal ganglia,13 cases of thalamus,10 cases of cerebral lobes,21 cases broken into the ventricle,<40ml 23 cases,40-50ml 30 cases,>50ml 17 cases.According to the time from onset to operation,there were 29cases of<6h,36 cases of 6-72h,5 cases of>72h,and no significant difference in general data between the two groups(P>0.05).2.The preoperative nerve function scores of the two groups were comparedThe preoperative NIHSS score of the craniotomy group:<5’,2 cases,5’-15’,49cases,>15’,8 cases.The preoperative NIHSS score of the minimally invasive surgery group:<5’,5 cases,5’-15’,58 cases,>15’,7 cases.And there was no significant difference in NHISS score in two group(P>0.05).3.The comparison of the operative time,first time hematoma clearance and postoperative rebleeding rate between 2 groupsThe operation time,the first hematoma clearance rate and the postoperative rebleeding rate were(181.53±24.83)min,(72.95±7.53)%and 13(22.04%),respectively.The operation time,the first hematoma clearance rate and the postoperative rebleeding rate were(39.61±7.21)min,(40.53±6.24)%,7.14%(5/70),respectively.The operation time and rebleeding rate of the patients in the craniotomy group were significantly better than those of the control group(P<0.05),and the first hematoma clearance rate in the minimally invasive surgery group was significantly lower than that of the control group(P<0.05).4.Two groups of patients with immediate,24h and 5D intracranial pressure after operationThe intracranial pressure of the patients in the craniotomy group was(19.44±4.13)mmHg,(16.19±4.04)mmHg,(13.49±2.59)mm Hg,respectively,and the intracranial pressure of the minimally invasive surgery group was(24.17±5.45)mmHg,(20.41±5.03)mmHg,(14.81±2.71)mmHg,respectively,after the minimally invasive surgery group,and the patients in the minimally invasive surgery group were operated after operation.Intracranial pressure in immediate,24h and 5D was significantly higher than that in the control group(P<0.05).5.Average time of hospitalization in two groups of patientsThe minimum hospitalization days for the craniotomy group were 13 days,the maximum hospitalization days were 35 days,the average hospitalization days were22.05±3.78 days,the minimum hospitalization days of the minimally invasive surgery group were 10 days,the maximum hospitalization days were 31 days,the average hospitalization days were 15.56±3.63 days,and the average hospitalization time of the minimally invasive surgery group was significantly lower than that of the craniotomy group(P<0.05).6.Comparison of follow-up prognostic indicators in two groups of patients after operationThe fatality rate of craniotomy group was 8.47%(5/59),and minimally invasive surgery group was 2.86%(2/70).After 6 months of discharge,the mRS score was followed up,the craniotomy group was 2.95±1.76,and the minimally invasive surgery group was 2.37±1.46.The mRS score in the minimally invasive surgery group was significantly lower than that in the craniotomy group(p<0.05).After 6 months of discharge,ADL-BI score was followed up.According to the score,it was divided into 100 points of self care,mild 75-95,moderate50-70,severe 25-45,and 0-20 points.Among them,the craniotomy group took care of 5cases,mild 12,moderate 23,severe 10,4,minimally invasive and moderate 8,moderate20,moderate 33,5 cases were severe and 2 cases were extremely severe.In the survival of all patients,according to the activities of self-care+mild+moderate definition,the severe+extreme severity was defined as heavy disability,and the daily living ability of the two groups was compared.The ADL-BI score of minimally invasive surgery group was significantly better than that of craniotomy group(P<0.05).Conclusion:The hematoma volume between 30 ml-60 ml act on hypertensive cerebral hemorrhage,although craniotomy hematoma removal of hematoma clearance rate is higher for the first time,can more effectively reduce postoperative intracranial pressure level,but the hematoma puncture drainage with low incidence of postoperative bleeding again,shorter hospitalization time,and can reduce the risk of death,improve the quality of survival. |
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