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目的探讨经颞部和额部两种入路下微创钻孔引流术治疗中等量基底节区高血压性脑出血临床疗效及安全性差异。方法选取2013年7月至2016年7月收治的中等量基底节区高血压性脑出血患者共110例作为研究对象,以随机数字表法分为A组(55例)和B组(55例),其中A组采用经颞部入路下微创钻孔引流治疗,B组患者采用经额部入路下微创钻孔引流治疗,比较两组患者术后血肿残余量,术后意识恢复情况,手术前后美国国立卫生研究院卒中量表(NIHSS)评分、中国卒中量表(CSS)评分,日常生活能力评分(ADL)-Barthel指数评分及术后并发症发生率。结果 B组患者术后3 d和7 d血肿残余量均显著少于A组(P均<0.05),术后3 d意识恢复率显著高于A组(P<0.01),两组患者术后7 d意识恢复率比较差异无统计学意义(P>0.05)。两组患者术后NIHSS评分均显著低于术前(P均<0.05),B组患者术后NIHSS评分和CSS评分均显著低于A组(P均<0.05)。两组患者术后ADL-Barthel评分均显著高于术前(P均<0.05),B组患者术后ADL-Barthel评分均显著高于A组(P<0.05)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论相较于颞部入路,经额部入路微创钻孔引流术治疗中等量基底节区高血压性脑出血可有效增加血肿清除量,促进意识恢复,改善受损神经功能和日常生活质量,且术后并发症发生率无增加。
Objective To investigate the clinical efficacy and safety of minimally invasive drilling and drainage in the treatment of moderate-level hypertensive cerebral hemorrhage in the basal ganglia by both temporal and frontal approaches. Methods A total of 110 patients with hypertensive intracerebral hemorrhage of moderate basal ganglia treated from July 2013 to July 2016 were selected as study objects and divided into group A (55 cases) and group B (55 cases) by random number table ), Of which group A was treated by minimally invasive drilling and drainage via the temporal approach. In group B, minimally invasive drilling drainage was used in group B, residual hematoma volume was compared between the two groups, and postoperative consciousness recovery NIHSS score, CSS score, ADL-Barthel index score and postoperative complication rate before and after surgery. Results The residual volume of hematoma in group B after operation was significantly less than that in group A at 3 d and 7 d (P <0.05), and the recovery rate at 3 d after operation was significantly higher than that of group A (P <0.01) There was no significant difference in consciousness recovery rate at 7 days (P> 0.05). The postoperative NIHSS scores of both groups were significantly lower than those of preoperative (P <0.05). The NIHSS score and CSS score of postoperative patients in group B were significantly lower than those in group A (all P <0.05). The postoperative ADL-Barthel scores of both groups were significantly higher than those before operation (all P <0.05). The ADL-Barthel scores of patients in group B were significantly higher than those in group A (P <0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). Conclusions Compared with the temporal approach, minimally invasive drilling and drainage through the frontal approach can effectively increase hematoma volume, promote consciousness recovery, improve the function of impaired nerves and daily life in moderate basal ganglia hypertensive intracerebral hemorrhage Quality, and no increase in the incidence of postoperative complications.