亚低温联合颅内血肿微创清除术治疗重症高血压脑出血的临床随机对照研究(1)
【摘要】 目的：探讨亚低温联合颅内血肿微创清除术治疗重症高血压脑出血的临床效果。方法：选取2013年8月-2016年5月本院神经外科收治的重症高血压脑出血患者100例作为本次研究对象，将其按照随机数字表法分为对照组和观察组，每组50例。对照组在常规对症治疗基础上给予颅内血肿微创清除術治疗，观察组在常规对症治疗基础上给予亚低温联合颅内血肿微创清除术治疗，治疗后对两组患者进行为期8周的随访观察。采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale，NIHSS)对两组患者治疗前、治疗后3 d的神经功能情况进行评价，并分别于治疗后2、8周采用Fugl-Meyer运动功能评定(Fugl-Meyer Motor Function Assessment，FMA)量表对患者运动功能进行评分，观察比较两组临床总有效率、残留血肿量、再出血率、治疗前后NIHSS评分、FMA评分和不良反应发生率。结果：(1)观察组临床总有效率为90.0%，明显高于对照组的68.0%，差异有统计学意义(P<0.05)；观察组病死率为2.0%，明显低于对照组的14.0%，差异有统计学意义(P<0.05)。(2)观察组残留血肿量为(9.7±3.5)mL，再出血率为14.0%，明显低于对照组的(26.2±4.3)mL和36.0%，差异均有统计学意义(P<0.05)。(3)治疗前，两组NIHSS评分、FMA评分比较，差异均无统计学意义(P>0.05)；治疗后，两组NIHSS评分、FMA评分均明显优于治疗前，且观察组明显优于对照组，差异均有统计学意义(P<0.05)。(4)观察组不良反应(感染、静脉血栓、肩手综合征、足内翻、足下垂)发生率为10.0%，明显低于对照组的36.0%，差异有统计学意义(P<0.05)。结论：临床上采用亚低温联合颅内血肿微创清除术治疗重症高血压脑出血，疗效显著，可显著改善神经功能及运动功能，提高患者治疗后的生活质量，且治疗过程中不良反应少，安全性高，具有较高的临床应用价值。
【关键词】 亚低温； 颅内血肿微创清除术； 重症高血压脑出血； 临床效果
Clinical Randomized Controlled Study on Mild Hypothermia Combined with Minimally Invasive Removal of Intracranial Hematoma in the Treatment of Severe Hypertensive Cerebral Hemorrhage/XIAO Wang.//Medical Innovation of China，2017，14(05)：031-035
【Abstract】 Objective：To explore the clinical effect of mild hypothermia combined with minimally invasive removal of intracranial hematoma in the treatment of severe hypertensive cerebral hemorrhage.Method：In the Department of Neurosurgery of our hospital from August 2013 to May 2016 100 cases of severe hypertensive intracerebral hemorrhage were selected as the research objects，and randomly divided into the control group and the treatment group，50 cases in each group.The control group on the basis of conventional symptomatic treatment was given intracranial hematoma removal treatment，the observation group on the basis of the conventional symptomatic treatment was given mild hypothermia combined with minimally invasive intracranial hematoma treatment，after treatment patients of two groups were observed for a period of 8 weeks of follow-up.The National Institutes of Health Stroke Scale(National Institute of Health stroke scale，NIHSS) were used to evaluate the neurological function in the treatment of 3 d patients in two groups before and after treatment，and in 2 weeks after treatment and 8 weeks after treatment by Fugl-Meyer motor function assessment(Fugl-Meyer Motor Function Assessment，FMA) scale the score of patients with motor function，the total clinical efficiency，residual hematoma volume，rebleeding rate before and after treatment，NIHSS score，FMA score and adverse reactions incidence of two groups were compared.Result：The total efficiency of the observation group was 90.0%，significantly higher than 68.0% of the control group，the difference was statistically significant(P<0.05).The mortality of the observation group was 2.0%，significantly lower than 14.0% of the control group，the difference was statistically significant(P<0.05).The residual hematoma of the observation group was (9.7±3.5)mL，and the bleeding rate was 14.0%，significantly lower than (26.2±4.3)mL and 36.0% of the control group，the differences were statistically significant(P<0.05).The comparison between two groups before treatment，NIHSS score，FMA score，there were no significant differences(P>0.05).After treatment，two groups of NIHSS score and FMA score were significantly better than those of before treatment，and the observation group was significantly better than the control group，the differences were statistically significant(P<0.05).The adverse reactions rate of the observation group (infection，venous thrombosis，shoulder hand syndrome，foot，foot drop) was 10.0%，significantly lower than 36.0% of the control group，the difference was statistically significant(P<0.05).Conclusion：Mild hypothermia combined with minimally invasive removal of intracranial hematoma in the treatment of severe hypertensive cerebral hemorrhage has a curative effect，function and exercise in patients with nerve function improve significantly，improve the quality of life of patients after treatment，and the treatment process of adverse reactions，high safety，it has a high value in clinical application., 百拇医药(肖旺)
【关键词】 亚低温； 颅内血肿微创清除术； 重症高血压脑出血； 临床效果
Clinical Randomized Controlled Study on Mild Hypothermia Combined with Minimally Invasive Removal of Intracranial Hematoma in the Treatment of Severe Hypertensive Cerebral Hemorrhage/XIAO Wang.//Medical Innovation of China，2017，14(05)：031-035
【Abstract】 Objective：To explore the clinical effect of mild hypothermia combined with minimally invasive removal of intracranial hematoma in the treatment of severe hypertensive cerebral hemorrhage.Method：In the Department of Neurosurgery of our hospital from August 2013 to May 2016 100 cases of severe hypertensive intracerebral hemorrhage were selected as the research objects，and randomly divided into the control group and the treatment group，50 cases in each group.The control group on the basis of conventional symptomatic treatment was given intracranial hematoma removal treatment，the observation group on the basis of the conventional symptomatic treatment was given mild hypothermia combined with minimally invasive intracranial hematoma treatment，after treatment patients of two groups were observed for a period of 8 weeks of follow-up.The National Institutes of Health Stroke Scale(National Institute of Health stroke scale，NIHSS) were used to evaluate the neurological function in the treatment of 3 d patients in two groups before and after treatment，and in 2 weeks after treatment and 8 weeks after treatment by Fugl-Meyer motor function assessment(Fugl-Meyer Motor Function Assessment，FMA) scale the score of patients with motor function，the total clinical efficiency，residual hematoma volume，rebleeding rate before and after treatment，NIHSS score，FMA score and adverse reactions incidence of two groups were compared.Result：The total efficiency of the observation group was 90.0%，significantly higher than 68.0% of the control group，the difference was statistically significant(P<0.05).The mortality of the observation group was 2.0%，significantly lower than 14.0% of the control group，the difference was statistically significant(P<0.05).The residual hematoma of the observation group was (9.7±3.5)mL，and the bleeding rate was 14.0%，significantly lower than (26.2±4.3)mL and 36.0% of the control group，the differences were statistically significant(P<0.05).The comparison between two groups before treatment，NIHSS score，FMA score，there were no significant differences(P>0.05).After treatment，two groups of NIHSS score and FMA score were significantly better than those of before treatment，and the observation group was significantly better than the control group，the differences were statistically significant(P<0.05).The adverse reactions rate of the observation group (infection，venous thrombosis，shoulder hand syndrome，foot，foot drop) was 10.0%，significantly lower than 36.0% of the control group，the difference was statistically significant(P<0.05).Conclusion：Mild hypothermia combined with minimally invasive removal of intracranial hematoma in the treatment of severe hypertensive cerebral hemorrhage has a curative effect，function and exercise in patients with nerve function improve significantly，improve the quality of life of patients after treatment，and the treatment process of adverse reactions，high safety，it has a high value in clinical application., 百拇医药(肖旺)