CT定位下微创软通道术在高龄20~30ml幕上血肿中的应用

目的:探讨CT定位下微创软通道术在高龄20~30ml幕上血肿中的应用效果。方法:选取2018年6月~2020年9月本院收治的60例高龄20~30mL幕上血肿患者,随机分为微创组及保守组,各30例。微创组采取CT定位下微创软通道手术治疗,保守组采取保守疗法。对比治疗前及出院时的美国国立卫生研究院卒中量表(NIHSS)评分及临床效果,并对比治疗前、治疗7d、治疗1个月的日常生活能力(Barthel指数评估),另比较治疗后3个月的预后情况[格拉斯哥预后量表(GOS)评价]及并发症发生情况。结果:两组出院时NIHSS评分均较治疗前降低,微创组出院时NIHSS评分低于保守组,差异均具有统计学意义(P<0.05);两组临床效果等级分布比较有统计学差异(P<0.05),微创组总有效率高于保守组,差异有统计学意义(P<0.05);Barthel指数评分在组间、时间、交互方面具有统计学差异(P<0.05),两组治疗7d、治疗后1个月Barthel指数均较治疗前升高,两组治疗1个月均高于治疗7d,微创组治疗7d、治疗后1个月均高于微创组,差异均具有统计学意义(P<0.05);两组治疗后3个月的GOS评分等级分布比较有统计学差异(P<0.05),微创组预后良好率高于保守组,差异有统计学意义(P<0.05);微创组总并发症发生率与保守组比较差异无统计学意义(P>0.05)。结论:CT定位下微创软通道手术在高龄20~30mL幕上血肿患者治疗中的临床效果、神经功能恢复、日常生活能力改善方面均优于保守疗法,且预后改善更为明显,安全性较好。

Application of minimally invasive soft channel surgery under CT localization in 20~30ml supratentorial hematoma in the elderly

Objective:To explore the application effect of minimally invasive soft channel surgery under CT positioning in 20~30ml supratentorial hematoma in the elderly.Methods:60 advanced age patients with 20~30ml supratentorial hematoma admitted our hospital from June 2018 to September 2020 were selected,who were randomly divided into minimally invasive group and conservative group,with 30 cases in each group.The minimally invasive group was treated with minimally invasive soft channel surgery under CT location,while the conservative group was treated with conservative therapy.The scores of National Institutes of Health Stroke Scale(NIHSS)before treatment and at discharge and clinical effects were compared between two group,and the ability of daily living(Barthel Index)before treatment,7d after treatment and 1 month after treatment were compared,and the prognosis of 3 months after treatment[Glasgow outcome scale(GOS)evaluation]and complications were also compared.Results:NIHSS scores in both groups at discharge were lower than that before treatment,which in the minimally invasive group was lower than that in the conservative group,and the differences were statistically significant(P<0.05).There was statistical difference in the distribution of clinical effect grades between the two groups(P<0.05),and the total effective rate of minimally invasive group was higher than that of conservative group,and the difference was statistically significant(P<0.05).The Barthel Index scores was statistical difference among groups,time and interactions(P<0.05),and the Barthel index of the two groups at 7d after treatment and 1 month after treatment were higher than those before treatment,which in the two groups at 1 month after treatment were higher than those at 7d after treatment,which in the minimally invasive group at 7d after treatment and 1 month after treatment were higher than those in the conservative group,and the differences were statistically significant(P<0.05).There was significant difference in the GOS grades distribution between the two groups(P<0.05),and the good prognosis rate of the minimally invasive group was higher than that of the conservative group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence rate of total complications between the minimally invasive group and the conservative group(P>0.05).Conclusion:In the treatment of 20~30ml supratentorial hematoma in the advanced age patients,the clinical effect,neurological function recovery and the improvement of daily living ability of the minimally invasive soft channel operation under CT location are better than those of the conservative treatment,and the prognosis is improved more obviously and the safety is better.