目的 对比传统骨瓣开颅血肿清除术与小骨窗入路血肿清除术治疗基底节区高血压脑出血的临床疗效.方法 60例高血压脑出血患者为研究对象,采用随机数字表法分配为观察组和对照组,每组各30例,对照组患者接受传统骨瓣开颅血肿清除术,观察组采用小骨窗入路血肿清除术.比较两组治疗效果(显效、有效和无效)、手术并发症(再出血、颅内感染和肺部感染)和日常生活能力量表(ADL) Barthel评分(术前、术后4周和术后12周).结果 观察组总有效率为93.3％,对照组总有效率为80.0％,观察组疗效优于对照组(P=o.084).并发症方面,观察组的首次手术后再出血率明显低于对照组(6.7％ vs30.0％);颅内感染率(3.3％vs20.0％)、肺部感染并发症发生率(16.7％vs40.0％)均低于对照组(均P＜0.05).此外,观察组术后4周和术后12周的Barthel评分与对照组也存在明显差异(P＜0.05).结论 较之传统骨瓣开颅血肿清除术,小骨窗入路治疗高血压脑出血疗效更为显著,并发症发生率更低,值得临床推广应用.%Objective To evaluate the clinical effect of small bone window craniotomy evacuation of intracranial hematoma in treating hypertensive cerebra9 hemorrhage.Methods Sixty patients with hypertensive cerebral hemorrhage were selected.They were randomly divided into the control group (30 cases) and observation group (30 cases).The control group was treated with conventional craniotomy evacuation of hematoma,while the observation group was treated with small bone window craniotomy evacuation of intracranial hematoma.Treatment efficacy (significantly effective,effective and ineffective),complication (rehamemorrhagia,intracranial infection and pulmonary infection) and Barthel index were compared between two groups.Comparison results and clinical data of these patients were retrospectively analyzed.Results Significantly effective in observation group (70.0％) was much more than control group (50.0％).Curative effect of observation group was superior to control group and the difference was significant (P ＜ 0.05).Amount of rehaemorrhagia in control group (30.0％) was more than observation group (6.7％),intracranial infection (20.0 ％ vs 3.3 ％) and pulmonary infection (40.0％ vs 16.7 ％) was same.Differences of the above indexes between two groups were all significant (P ＜ 0.05).Moreover,Barthel index of observation group was much better than control group (P ＜ 0.05).Conclusion Treating hypertensive cerebral hemorrhage with minimally invasive intracranial hematoma is remarkably effective.It should be promoted and practiced extensively.
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