| Objective:This thesis aims to compare the clinical effects of minimally invasive hematoma evacuation and devascularized hematoma evacuation in patients with hypertensive intracerebral hemorrhage,and to explore the best indications of the two surgical procedures,so as to provide reference for the standardized treatment of clinical hypertensive basal ganglia hemorrhage value.Methods:A retrospective analysis of 200 patients with hypertensive basal ganglia hemorrhage with a hematoma volume of 30 mL to 100 mL from July 2017 to July 2018 in our hospital was treated with minimally invasive hematoma evacuation and devascularized hematoma evacuation.Clinical data.According to the amount of hematoma,the patients were divided into 30mL～50mL,51mL～70mL,71mL～100mL.Compared with the minimally invasive hematoma evacuation group and the deboned hematoma evacuation group,2 weeks after operation and 3 months after operation.The mortality of the patients was compared between the twogroups of patients with GCS and NIHSS scores before and 2 weeks after surgery.The neurological recovery and related complications occurred in the patients who died at 3 months after operation.The volume of edema around the brain tissue was compared between the two groups at 4 to 6days after operation.The hospitalization time and hospitalization cost of the two groups were compared.The good rate of daily living ability(ADL)of the patients who died in the 3 months after operation was compared.Results:1.Comparison of basic data between the two groups: age,hypertensive course,duration of diabetes,blood pressure at admission,GCS score at admission,and hematoma volume in patients with minimally invasive hematoma evacuation There was no statistical significance(P >0.05).2.Comparison of postoperative mortality between the two groups: at2 weeks and 3 months after surgery,the mortality rate of minimally invasive hematoma removal in patients with hematoma volume of30mL～50mL was significantly lower than that in patients with bone flap removal(P <0.05),and the mortality rate of patients with hematoma volume of 51mL～70mL and 71mL～100mL,respectively,showed no significant difference between the two groups(P >0.05).3.Comparison of GCS and NIHSS scores between the two groups of patients who died at 2 weeks after surgery: In patients who did not die at2 weeks after surgery,the amount of hematoma was 30 mL～50 mL,and the patients in the minimally invasive hematoma evacuation group went The GCS score and NIHSS score of the patients with skeletal hematoma evacuation group were statistically significant(P<0.05),and the hematoma volume was 51mL～70mL,71mL～100mL.There was no significant difference in GCS and NIHSS score between the two groups.P>0.05).4.Comparison of neurological recovery in patients who did not die at3 months after surgery: the amount of hematoma was 30 mL to 50 mL,and the mRS scores of patients in the minimally invasive hematoma evacuation group and the patients with deboned hematoma evacuation group The difference was statistically significant(P <0.05),and the amount of hematoma was 51mL～70mL,71mL～100mL.There was no significant difference in mRS score between the two groups(P >0.05).5.Comparison of postoperative complications related to surgery in the two groups: hematoma volume was 30mL～50mL,51mL～70mL,71mL～100mL,in patients with minimally invasive hematoma evacuation group and patients with deboned hematoma evacuation group There was no significant difference in the incidence of rebleeding and infection after operation(P >0.05).6.Comparison of NIHSS scores between the two groups of patients without death before surgery and 2 weeks after surgery: before surgery,there was no significant difference in NIHSS scores between the minimally invasive hematoma removal group and the bone flap hematoma removal group in patients with hematoma volumes of30mL～50mL,51mL～70mL,and 71mL～100mL(P >0.05).At 2 weeks after surgery in patients who were not killed,hematoma volume of 30 ml～ 50 ml,minimally invasive removal of hematoma group of patients and to removal of bone flap hematoma group of patients with NIHSS score differences statistically significant(P < 0.05),hematoma volume of 51 ml to 70 ml,71 ml to 100 ml,minimally invasive removal of hematoma group of patients and to removal of bone flap hematoma group of patients with NIHSS score difference has no statistical significance(P > 0.05).7.The volume of edema around the brain tissue between the two groups was 4～6 days after operation: the amount of hematoma was30mL～50mL,and the volume of edema around the brain tissue of the minimally invasive hematoma evacuation group was significantly smaller than that of the deboned hematoma evacuation group(P <0.05),the amount of hematoma was 51mL～70mL.There was no significant difference in the volume of edema around the brain tissue between the two groups(P >0.05).The amount of hematoma was 71mL～100mL.The brain tissue of patients with minimally invasive hematoma evacuation group The volume of surrounding edema was significantly greater than that of the deboned hematoma evacuation group(P <0.05).8.Comparison of hospitalization time and hospitalization cost between the two groups: the hematoma volume was 30mL～50mL,and the hospitalization time of the minimally invasive hematoma evacuation group was significantly shorter than that of the degenerative hematoma evacuation group(P <0.05).There were no significant differences in hospitalization time between the two groups(51>70mL,71mL～100mL)(P >0.05).The amount of hematoma was 30mL～50mL,51mL～70mL,71mL～100mL.The hospitalization cost of patients with minimally invasive hematoma evacuation group was significantly less than that of patients with deboned hematoma evacuation group(P <0.05).9.Comparison of the good rate of daily living ability(ADL)in the two groups of patients who died at 3 months after surgery: the good rate of postoperative ADL in patients with minimally invasive group was significantly higher than that in patients with decompressed valve group.(P <0.05).Conclusion:1.Patients with cerebral hemorrhage with a hematoma volume of 30mL～50mL,with minimally invasive surgery,have more advantages than treatment with deboned hematoma evacuation,have lower mortality,and are more conducive to the recovery of neurological function in patients.The edema around the brain tissue is less severe,the patient stays shorter,the treatment costs are lower,and the prognosis is better.Therefore,patients with a hematoma volume are more suitable fortreatment with minimally invasive hematoma evacuation.2.Patients with cerebral hemorrhage with a hematoma volume of 51 mL to 70 mL,patients treated with minimally invasive surgery have shorter hospital stays and lower treatment costs.Therefore,patients with an interval of hematoma can be treated with minimally invasive hematoma removal if they consider economic factors.3.Patients with cerebral hemorrhage with a hematoma volume of 71 mL to 100 mL can be used to reduce the intracranial pressure of the patient. |
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