Abstract
Objective To explore the surgical techniques and therapeutic effects of hematoma evacuation for hypertensive cerebral hemorrhage(HCH)with different bleeding sites under neuroendoscopy.Methods This study enrolled 101 patients with HCH treated in our hospital from May 2022 to January 2024.Based on CT imaging results,patients were divided into lobar cerebral hemorrhage group(n=43)and basal ganglia hemorrhage group(n=58).The Pearson was used to analyze the correlations between cerebral microcirculation indicators and the scores of national institutes of health stroke scale(NIHSS),mini mental state examination(MMSE),and the Barthel index(BI)of activities of daily living.The generalized estimating equation was employed to analyze the improvement effects of neuroendoscopic hematoma evacuation on cerebral microcirculation indicators in patients with different hemorrhage locations.A difference-in-differences equation model with full specifications was applied to analyze the improvement effects of neuroendoscopic hematoma evacuation on NIHSS score,MMSE score,and BI score in patients with different hemorrhage locations,incorporating baseline indicators as control variables.Results The operative time of basal ganglia hemorrhage group was significantly longer than those of lobar cerebral hemorrhage group,and the differences of NIHSS,MMSE,BI,mean transit time(MTT),cerebral blood flow(CBF),cerebral blood volume(CBV)and mean arterial pressure(MAP)before and after treatment were significantly smaller than those of lobar cerebral hemorrhage group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The correlation analysis results showed that MTT was positively correlated with NIHSS,and negatively correlated with BI and MMSE;CBF,CBV and MAP were negatively correlated with NIHSS,but positively correlated with BI and MMSE,the differences were statistically significant(P<0.05).The result of generalized estimating equation analysis showed that the improvement of MTT,CBF,CBV and MAP in patients with lobar cerebral hemorrhage group was better than those in patients with basal ganglia hemorrhage group,the differences were statistically significant(P<0.05).The result of difference-in-differences equation model analysis showed that increase of age,prolongation of MTT and prolongation of the time from onset to operation had positive effects on NIHSS score(B=0.884,1.291,0.758,P<0.05),and had negative effects on MMSE score(B=-1.014,-1.569,-0.821,P<0.05).The prolongation of MTT had a negative effect on BI score(B=-0.973,P<0.05).The increase of CBV,CBF and MAP had a negative effect on NIHSS score(B=-0.841,-0.767,-1.213,P<0.05),and had a positive effect on MMSE and BI score(MMSE:B=0.932,0.738,0.874;BI:B=0.897,0.751,0.842,P<0.05).Conclusion Neuroendoscopic hematoma evacuation can improve the NIHSS score,MMSE score,BI score of patients with HCH by adjusting MTT,CBF,CBV and MAP,and the improvement effect of patients with lobar cerebral hemorrhage is significantly better than that of patients with basal ganglia hemorrhage.关键词
神经内镜/血肿清除术/高血压脑出血(HCH)/基底节区出血/脑叶出血Key words
neuroendoscopy/hematoma evacuation/hypertensive cerebral hemorrhage(HCH)/basal ganglia hemorrhage/lobar cerebral hemorrhage分类
医药卫生
