显微镜下脑内血肿清除术与神经内镜血肿清除术治疗高血压脑出血的对比研究OA

Objective To explore the differences in clinical efficacy between microscopic intracerebral hematoma evacuation and neuro-endoscopic hematoma evacuation in the treatment of hypertensive intracerebral hemorrhage,and to provide a basis for the precise selection of surgical methods in clinical practice.Methods A total of 116 patients with hypertensive cerebral hemorrhage admitted to the First People's Hospital of Zhengzhou from January 2022 to December 2024 were selected and divided into the microscope group(58 cases)and the neuroendoscopy group(58 cases)by the random number table method.Both groups underwent surgery within 24 hours of onset.The microscopic group was treated with traditional craniotomy and hematoma evacuation under a microscope,while the neuroendoscopy group was treated with neuroendoscopic-assisted hematoma evacuation.The operation time,intraoperative blood loss,hematoma clearance rate,postoperative rebleeding rate,intracranial infection rate,hospital stay,as well as NIHSS score at 1 month,mRS Score at 3 months,and GOS score at 6 months after the operation were compared between the two groups.Monitor the dynamic changes of cerebral blood flow,blood flow velocity,intracranial pressure and the levels of inflammatory factors(IL-6,TNF-α)by transcranial Doppler ultrasound after the operation.The effective rate of treatment and the incidence of adverse reactions in the two groups were statistically analyzed.Results Compared with the microscope group,the neuroendoscopy group had shorter operation time,less intraoperative blood loss and higher hematoma clearance rate(P<0.05);The postoperative rebleeding rate and intracranial infection rate in the neuroendoscopy group were both lower than those in the microscopy group,and the hospital stay was also shorter(P<0.05).In terms of neurological function recovery,the NIHSS score of the neuroendoscopy group was lower one month after the operation(P<0.05).The proportions of mRS Score≤2 at 3 months and GOS score≥4 at 6 months were significantly higher than those in the microscope group(P<0.05).Compared with the microscope group,the cerebral blood flow and blood flow velocity in the neuroendoscopy group were higher 72 hours after surgery,the intracranial pressure was lower,and the levels of IL-6 and TNF-α decreased more significantly(P<0.05).The effective rate of treatment in the neuroendoscopy group was 77.6%,which was higher than 58.6%in the microscope group(P<0.05).The incidence of adverse reactions was 12.1%,which was lower than 24.1%in the microscope group(P<0.05).Conclusion Compared with microscopic intracerebral hematoma evacuation,neuroendoscopic hematoma evacuation for hypertensive intracerebral hemorrhage has significant advantages in reducing surgical trauma,improving the effect of hematoma evacuation,lowering the incidence of complications,and promoting the recovery of neurological function.Its regulatory effect on cerebral hemodynamics and neuroinflammation may be the key to improving prognosis.