软通道微创治疗服用抗血小板药物的大量基底节出血患者的临床疗效观察OA
Clinical efficacy of soft channel minimally invasive therapy in patients with large amount basal ganglia hemorrhage taking antiplatelet drugs
目的 探究软通道微创治疗服用抗血小板药物的大量基底节出血患者的临床疗效.方法 回顾性分析黄冈市中心医院神经外科2023 年5 月—2025 年3 月收治的104 例服用抗血小板药物的大量基底节出血患者的临床资料,根据随机数字表法分为微创组(n=52)和开颅组(n=52).微创组采用软通道微创治疗,开颅组常规采用开颅血肿清除术治疗,于术后2 周重启抗板药物治疗,比较两组围手术期基本情况并分析两组不同时间点 GCS 评分和血肿清除率的变化,同时比较两组术后并发症发生率和近期预后的差异.结果微创组在手术时间、术中出血量、住院花费、住院时间四方面的表现均优于开颅组(P<0.05),开颅组仅在术后1d 的血肿清除效果更佳(P<0.05),术后再出血率、术后并发症发生率均高于微创组(P<0.05),微创组术后3d,7d 余下血肿体积小于开颅组(P<0.05),均具有统计学意义.两组术前 GCS 评分差异无统计学意义(P>0.05),术后呈逐渐升高趋势(P<0.05),微创组升高趋势更明显,术后 3 d、7 d 微创组 GCS 评分高于开颅组(P<0.05).微创组近期预后不佳患者数量少于开颅组(P<0.05).结论 与传统的开颅血肿清除术相比,软通道微创治疗服用抗血小板药物的大量基底节出血患者可减少术后并发症的发生率,特别是术后二次出血的发生,加快患者的术后恢复,改善患者的近期预后.
Objective To explore the clinical efficacy of soft channel minimally invasive therapy for patients with large basal ganglia hemorrhage taking antiplatelet drugs.Methods The clinical data of 104 patients with large basal ganglia hemorrhage taking antiplatelet drugs admitted to Department of Neurosurgery,Huanggang Central Hospital from May 2023 to March 2025 were analyzed retrospectively.All patients were divided into a minimally invasive group(n=52)and a craniotomy group(n=52)according to the random number table method.The minimally invasive group received soft channel minimally invasive evacuation,while the craniotomy group received conventional craniotomy for hematoma removal,reinitiation of antiplatelet therapy at 2 weeks postoperatively.The perioperative basic conditions of the two groups were compared,and the changes in Glasgow coma scale(GCS)scores and hematoma removal rate at different time points were analyzed.The incidence of postoperative complications and short-term prognosis were also statistically analyzed.Results The minimally invasive group demonstrated statistically significant superiority over the craniotomy group in terms of operative time,intraoperative blood loss,hospitalization cost,and length of hospital stay(all P<0.05).In contrast,the craniotomy group exhibited a more favorable residual hematoma volume on postoperative day 1,indicating a superior hematoma clearance efficacy compared with the minimally invasive group(P<0.05).The rebleeding rate and the incidence of postoperative complications were higher than those in the minimally invasive group(P<0.05).The residual hematoma volume in the minimally invasive group was smaller than that in the craniotomy group at 3 days and 7 days after surgery(P<0.05).There was no significant difference in the preoperative GCS scores between the two groups,and they showed a gradual upward trend after surgery(P<0.05).The upward trend was more obvious in the minimally invasive group,and the GCS scores in the minimally invasive group were higher than those in the craniotomy group at 3 days and 7 days after surgery(P<0.05).The number of patients with poor short-term prognosis in the minimally invasive group was less than that in the craniotomy group(P<0.05).Conclusions Compared with traditional craniotomy for hematoma removal,soft channel minimally invasive treatment for patients with large basal ganglia hemorrhage taking antiplatelet drugs can reduce the incidence of postoperative complications,especially postoperative rebleeding,accelerate the postoperative recovery of patients,and improve the short-term prognosis of patients.
盛志田;陈大瑜;魏小川;熊俊彦;张化明
438000 黄冈,黄冈市中心医院神经外科438000 黄冈,黄冈市中心医院神经外科438000 黄冈,黄冈市中心医院神经外科武汉科技大学附属华润武钢总医院神经外科武汉科技大学附属华润武钢总医院神经外科
医药卫生
软通道基底节出血微创术后并发症预后
soft channelbasal ganglia hemorrhageminimally invasivepostoperative complicationprognosis
《临床神经外科杂志》 2026 (3)
248-253,260,7
湖北省卫生健康委员会科研项目(WJ2021M032)湖北省自然科学基金项目(2026AFC0451)
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