高血压脑出血手术治疗时机的比较研究

THE TIMING OF SURGICAL TREATMENT FOR HYPERTENSIVE INTRACEREBRAL HEMORRHAGE

目的:探讨高血压脑出血开窗手术时机的选择及疗效分析。方法:回顾分析65例基底节区脑出血患者(出血量30￣70ml)为研究对象,按手术实施时间分为3组:A组7小时以内手术者22例(超早期组);B组7￣24小时以内手术者23例(早期组);C组24-48小时手术者20例(延期组)。均行开窗微创血肿清除术,比较3组出院时按GOS评分,对比疗效。结果:按GOS评分A组Ⅰ级1例占4%,Ⅲ级2例占10%,Ⅳ￣Ⅴ级19例占86%,发生再出血3例。B组Ⅰ级2例占7%,Ⅲ级7例占30%,Ⅳ￣Ⅴ级14例占63%,再出血2例。C组Ⅰ级6例占30%,Ⅱ级1例5%,Ⅲ级5例占25%,Ⅳ￣Ⅴ级8例占40%。三者之间有差异有统计学意义(P<0.001)。结论:超早期手术可提高高血压脑出血患者的生存质量,降低病死率和致残率。

Objective： To investigate retrospectively the timing of hematoma evacuation for hypertensive intracerebral hemorrhage and its therapeutic efficacy.Methods：65patients with basal ganglia hemorrhage were divided into 3 groups based on the time of surgery after the onset： group A,22 cases, B, 23 cases, and C,20 cases, received operation within 7h,between 7-24h,and between 24-48h respectively. All patients underwent minimal invasive surgery for hematoma evacuation, and their outcomes were evaluated by Glasgow Outcome Scale（GOS）. Results： Group A ：GOS grade Ⅰ lcase（4%）, Ⅲ 2cases（10%）,Ⅳ- Ⅴ 19 cases（86%）,3 cases rehemorrhaged; group B Ⅰ, 2case（7%）,Ⅲ 7cases（30%）,Ⅳ-Ⅴ 14 cases（63%）,2cases rehemorrhaged; group C： Ⅰ 6case（30%）, Ⅱ lcase （5%）, Ⅲ 5cases （25%）, Ⅳ-Ⅴ8 cases （40%）.There were significant differences among the three groups （P〈0.05）. Conclusion： Very early surgical operation can improve the living quality of the patients suffered from hypertensive cerebral hemorrhage and cut down the mortality and mutilation rate.