目的 探讨显微镜小骨窗开颅血肿清除术和硬通道穿刺血肿引流术两种术式在高血压脑出血老年患者中的各自优势。方法 选取2021年1月—2024年4月进行治疗的老年高血压脑出血患者100例,采用随机数字表法分为硬通道穿刺组（硬通道穿刺血肿引流术）和骨窗开颅组（显微镜小骨窗开颅血肿清除术）,每组各50例,对比分析两组治疗效果及家属对手术的接受度。结果 硬通道穿刺组手术时间、住院时间显著短于骨窗开颅组（P<0.05）,血肿清除率、格拉斯哥预后量表（GOS）评分均显著高于骨窗开颅组（P<0.05）;术后并发症发生率显著低于骨窗开颅组（P<0.05）;患者家属对手术接受度显著高于骨窗开颅组（P<0.05）。术前两组格拉斯哥昏迷量表（GCS）、日常生活活动（ADL）、健康调查量表36（SF-36）评分比较,差异均无统计学意义（P>0.05）;术后3个月,两组GCS、ADL、SF-36评分均较术前显著改善（P<0.05）,且硬通道穿刺组GCS、ADL、SF-36评分均显著优于骨窗开颅组（P<0.05）。结论 出于对患者群体（高血压脑出血老年人群）特点的考虑,硬通道微创穿刺因其“手术时间短、创伤小”的特点不失为一种能被不愿接受开颅手术的患者家属折中选择的好办法,在特定人群中可推广。

Objective To compare the effects of microscopic small bone window craniotomy hematoma removal and hard channel puncture hematoma drainage on the prognosis and family acceptance of elderly hypertensive intracerebral hemorrhage （HICH）. Methods A total of 100 elderly patients with HICH admitted from January 2021 to April 2024 were selected as research subjects, and randomly divided into a hard channel puncture group （hard channel puncture hematoma drainage） and a bone window craniotomy group （microscopic small bone window craniotomy hematoma removal）, with 50 cases in each group. The effects of the two groups and the acceptance of surgery of family were compared and analyzed. Results The operation time and hospital stay in the hard channel puncture group were significantly shorter than those in the bone window craniotomy group （P<0.05）, and the clearance rate of hematoma and Glasgow outcome scale （GOS） score were significantly higher （P<0.05）. The incidence of postoperative complications in the hard channel puncture group was significantly lower than that in the bone window craniotomy group （P<0.05）. The surgical acceptance of patients' family members of the hard channel puncture group was significantly higher than that of the bone window craniotomy group （P<0.05）. There were no significant differences in the scores of Glasgow coma scale （GCS）, activity of daily living （ADL）, and short form 36 （SF-36） between the two groups before surgery （P>0.05）. At postoperative 3 months, the scores of GCS, ADL, and SF-36 between the two groups were significantly improved （P<0.05）, and the scores in the hard channel puncture group were significantly better than those in the bone window craniotomy group （P<0.05）. Conclusion In consideration of the characteristics of the HICH patients group, hard channel puncture drainage is a good choice for the families of patients who are unwilling to undergo craniotomy due to its advantages of short hospital stay and small trauma, and can be promoted in specific populations.