| Objective: Through the comparative analysis of the clinical effects of minimally invasive neuroendoscopic surgery and small bone window on hypertensive intracerebral hemorrhage patients,this paper provides a reference for the selection of appropriate minimally invasive surgery for hypertensive intracerebral hemorrhage.Materials and Methods: Choose between December 2015 and December 2017 in our hospital diagnosis and adopt neural endoscopic minimally invasive surgery and small bone window treatments of patients with hypertensive cerebral hemorrhage(30 ml < the bleeding < 80 ml)of 126 cases,according to the method divided the patients into neural endoscopic surgery group(63 cases),small bone window group(63 cases),at the same time,choose 60 patients to the hospital for physical examination personnel,as indicators of related research of the control group,in their respective accordingly after surgical treatment,analyzing related projects: Analysis of general sociological data of patients in each group(mean age,sex ratio,basic diseases,duration of disease,etc.);Analysis of preoperative and postoperative clinical effects of patients in each group(incidence of hydrocephalus,indwelling time of ventricular drainage tube,operation time,surgical bleeding volume,postoperative hematoma clearance rate),etc.Inflammatory indicators(CRP,PCT,IL-6,IL-8 and TNF-?)were analyzed in each group.Preoperative and postoperative NDS score,GCS score and Graeb score of each group were statistically analyzed.The therapeutic effects(excellent,good,medium and poor)of each group were compared and analyzed.The proportion of postoperative complications(cerebral hemorrhage,respiratory tract infection,digestive tract infection,electrolyte disturbance)in each group was statistically analyzed.Statistical analysis of ADL prognosis in each group;Univariate and multivariate statistical analysis of risk factors for long-term prognosis of patients in each group.Results: General data analysis of sociology: two groups of patients in the sex ratio,average age,disease stage,the bleeding,hematoma location projects,such as statistical data P value is 0.554,0.450,0.178,0.102,0.090,were greater than 0.05,the difference is not statistically significant.Short-term efficacy analysis: hematoma clearance rate and hematoma recurrence: in the analysis of complete hematoma clearance,most hematoma clearance,hematoma recurrence and patient mortality of the two groups,the P values of statistical data were 0.024,0.045,0.038 and 0.049,all of which were less than 0.05,and the difference was statistically significant.The incidence of hydrocephalus and indwelling time of ventriculostomy tube: in the analysis of the incidence of hydrocephalus and indwelling time of ventriculostomy tube in the two groups,the P value of statistical data was 0.038,0.046,both less than 0.05,and the difference was statistically significant.Operation time and intraoperative blood loss: in the analysis of operation time and intraoperative blood loss and other items of patients in the two groups,the P values of statistical data were 0.039 and 0.029,both of which were greater than 0.05,and the difference was not statistically significant.Recovery time and infection status of hemiplegia: in the analysis of hemiplegia recovery time and infection status of patients in the two groups,the P value of statistical data was 0.049,0.038,both less than 0.05,and the difference was statistically significant.Duration of hospital stay and mortality: in the analysis of duration of hospital stay and mortality of patients in the two groups,the P values of statistical data were 0.013 and 0.025,both less than 0.05,and the difference was statistically significant.Inflammatory factor analysis: CRP,PCT,IL-6,IL-8 and TNF-?: before the operation,the data of the two groups were the same,and the data of the two groups were all greater than 0.05,the difference was not statistically significant.After surgery,the decrease of the data in the neuroendoscopic group was significantly greater than that in the small bone window group.Compared with the data in each group,all P were less than 0.05,and the difference was statistically significant.NDS,GOS and Graeb scores: compared with the preoperative NDS scores of patients in the two groups,the P value was 0.102,and the difference was not statistically significant.After the NDS score comparison,the P value was 0.015,and the difference was statistically significant.The preoperative GOS score of the two groups was 0.133,and the difference was not statistically significant.After the NDS score comparison,the P value was 0.034,and the difference was statistically significant.The comparison of preoperative Graeb score between the two groups showed that the P value was 0.098,and the difference was not statistically significant.After the NDS score comparison,the P value was 0.023,and the difference was statistically significant.Forward curative effect: the treatment effect: two groups of patients in postoperative treatment effect of statistical analysis,and efficient to neural endoscopic group was obviously higher than that of small bone window group,in excellent,good,poor,project analysis,statistical data P value is 0.023,0.034,0.045,0.039,0.026,are less than 0.05,the difference is statistically significant;Postoperative complications: neural endoscopic treatment group again in patients with cerebral hemorrhage of intracranial infection,a respiratory infection,gastrointestinal complications such as infection,electrolyte disorder significantly lower than that of small bone window in groups,among them the occurring rate of cerebral hemorrhage,intracranial infection and aspects and so on,P value is 0.035,0.030 and 0.047,are less than 0.05,the difference is statistically significant;ADL prognosis grading: the living ability of patients in the neuroendoscopic group was significantly improved after surgery,and most patients were in grade I?II,while the effect in the small bone window group was poor,and most patients were in grade II?III.In the level I statistical analysis,the P value was 0.045,and the difference was statistically significant.Prognostic factors analysis: recent death Logistic multi-factors analysis: GOS score,hematoma volume,ventricular blood product,operation time and operation method in project analysis,statistical P value is 0.034,0.028,0.037,0.034,0.049,are less than 0.05,the difference is statistically significant;Logistic multivariate analysis of good recovery: in the analysis of the volume of ventricular volume,operation timing and operation method,the P value of statistical data was 0.030,0.024 and 0.027,all of which were less than 0.05,and the difference was statistically significant.Long-term prognosis Logistic multivariate analysis: in the analysis of patients' age,hematoma volume,ventricular volume,operation timing,operation method and other items,the P values of statistical data were 0.045,0.034,0.032,0.021 and 0.029,all of which were less than 0.05,and the difference was statistically significant.Conclusions:(1)The neuroendoscopic group and the small bone window craniotomy group had relatively uniform general sociological data before the operation,and there was little difference between the data of the two groups in terms of gender ratio,average age,disease grade,blood loss and location of hematoma,etc.,which laid a foundation for the later postoperative research and laid a foundation for the following research.(2)Neural endoscopic micro Chuang Shu hypertension cerebral hemorrhage patients treated in the near future curative effect significantly better than that of small bone window craniotomy surgery,patients have a higher rate of recurrent hematoma clearance rate,the lower the hematoma,the incidence of hydrocephalus,operation time,intraoperative blood loss,such as hemiplegia recovery time,mortality,cerebral hemorrhage patients treated in neural endoscopic micro Chuang Shu zha has more safety and reliable curative effect,worth to continue massive popularization in clinical.(3)Micro Chuang Shu neural endoscopic treatment of hypertensive cerebral hemorrhage patients with inflammatory effect is significantly lower than that of small bone window craniotomy surgery,in patients with postoperative has lower concentration of CRP and PCT,interleukins(IL-6,IL-8)and tumor necrosis factor(TNF alpha),etc.,at the same time can reduce cerebral hemorrhage patients state of nerve defect,accelerate the patient's nerve recovery state,giving clinical must be inspired.(4)Neural endoscopic micro Chuang Shu treatment of hypertensive cerebral hemorrhage is appropriate for small bone window,patients can have a better long-term prognosis,reduce the mortality of the recent adequately,blood volume of brain hematoma,ventricle,operation time and operation are the key factors that lead to long-term prognosis in patients with or better,fully confirmed neural endoscopic micro Chuang Shu is treatment of hypertensive cerebral hemorrhage more ideal way,give the clinical certain inspiration. |
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