锁孔微创入路治疗高血压脑出血的临床疗效研究

Study on the Clinical Efficacy of Keyhole Minimally Invasive Approach in the Treatment of Hypertensive Cerebral Hemorrhage

摘要: 目的：探讨锁孔微创入路治疗高血压脑出血的临床效果，从手术创伤、血肿清除效率、神经功能恢复、并发症风险及中期预后多维度综合评价其安全性与有效性，为临床手术方式选择提供可靠循证依据。方法 选取2022年1月~2024年12月本院神经外科收治的高血压脑出血手术患者60例，按手术方式分为锁孔微创入路组(观察组)与传统开颅血肿清除组(对照组)，各30例。对比两组围手术期指标、术后24 h血肿清除率、术前及术后不同时点GCS评分、NIHSS评分、Barthel指数、术后并发症发生率，并行术后6个月随访，采用GCS评分评估预后。结果 观察组手术时间、术中出血量、术后住院时间均显著低于对照组(P < 0.05)，术后24 h血肿清除率显著更高(P < 0.05)；术后3 d、7 d、14 d观察组GCS评分高于对照组，术后1个月、3个月观察组NIHSS评分更低、Barthel指数更高(均P < 0.05)；观察组术后并发症总发生率13.33%，显著低于对照组的40.00% (P < 0.05)；术后6个月观察组预后良好率83.33%，显著高于对照组的56.67% (P < 0.05)。结论 锁孔微创入路治疗高血压脑出血创伤小、血肿清除确切、术后恢复快、并发症发生率低，对脑组织及神经功能保护效果优异，可有效改善患者神经功能与日常生活能力，提升中期预后，是安全高效、值得基层临床推广的微创手术方式。

Abstract: Objective: To investigate the clinical effect of keyhole minimally invasive approach in the treatment of hypertensive intracerebral hemorrhage (HICH), and to comprehensively evaluate its safety and effectiveness from the perspectives of surgical trauma, hematoma clearance, neurological recovery, complications and mid-term prognosis, so as to provide reliable evidence for clinical surgical selection. Methods: Sixty patients with HICH who underwent surgery in our hospital from January 2022 to December 2024 were enrolled. They were assigned to the keyhole minimally invasive group (observation group, n = 30) and conventional craniotomy group (control group, n = 30). Perioperative indicators, hematoma clearance rate, GCS, NIHSS, Barthel index, complications and 6-month prognosis were compared. Results: The operation time, intraoperative blood loss and hospital stay in the observation group were significantly lower than those in the control group (P < 0.05). The hematoma clearance rate at 24 h after operation was significantly higher (P < 0.05). GCS scores at 3 d,7 d,14 d were higher, while NIHSS scores were lower and Barthel index was higher at 1 and 3 months in the observation group (all P < 0.05). The total complication rate was 13.33% in the observation group and 40.00% in the control group (P < 0.05). At 6-month follow-up, the favorable prognosis rate was 83.33% in the observation group, higher than 56.67% in the control group (P < 0.05). Conclusion: Keyhole minimally invasive approach for HICH is characterized by less trauma, more effective hematoma evacuation, faster recovery and lower complications. It provides better protection of brain tissue and neurological function, significantly improves mid-term prognosis, and is worthy of wide clinical application.