小骨窗开颅血肿清除率对高血压脑出血的预后影响

Craniotomy with small bone hole for hypertensive intracerebral hemorrhage and the effect of hematoma clearance rate on the prognosis after operation

目的评价小骨窗开颅术血肿清除率对高血压脑出血（hypertensive intracerebral hemorrhage，HICH）的预后影响。方法241例施行小骨窗开颅术的HICH病例，根据血肿清除率分为A组（血肿清除率≤60％～〈75％，70例）、B组（血肿清除率≥75％～〈90％，117例）、C组（血肿清除率〉90％，54例），对三组的术后再出血率、颅内感染率、血肿完全吸收时间及术后28天神经功能缺损评分进行对比研究。结果随着血肿清除率的增加，病人术后清醒时间及血肿完全吸收时间明显缩短（P＜O．01），神经功能明显改善（P〈O．05），治疗有效率显著提高，C组最有效（P〈O．01）。死亡率C组较A组明显降低（P〈O．01）。结论血肿清除率是影响小骨窗开颅术治疗HICH预后的首要因素。

Objective To evaluate the effect of hematoma clearance rate on the prognosis by craniotomy with small bone hole for hypertensive intracerebral hemorrhage （HICH）. Methods Two hundreds fourty one patients of HICH treated by craniotomy with small bone hole were divided into 3 groups according to hematoma clearance rate： group A （≤60%-75%, 70 cases）, group B （≥75%-90%, 117 cases） and group C （〉90%, 54 cases）. A comparison analysis of the three groups was made based on the post-operation re-hemorrhage rate, intracranial infection rate, hematoma complete absorbtion time and neurologic function deficit scoring 28 days after operation. Results With the increase of the hematoma clearance rate, the post--peration re-hemorrhage rate and hematoma complete absorbtion time were significantly reduced（P〈0.01）, neurologic function were clearly improved（P〈0. 05）, the effective rate were evidently increased（P〈0.01）and the effective rate was the most in C group. The mortality rate of group C was distinctly lower than group A（P〈0. 01）. Conclusion The hematoma clearance rate is an important factor affecting the prognosis of HICH by craniotomy with small bone hole.