外科干预对高血压脑出血后脑水肿转归的影响

The effect of surgical intervention to brain edema development after hypertensive intracerebral hemorrhage

目的探讨手术干预对高血压脑出血后,血肿周围脑水肿形成与发展的影响。方法 选择高血压脑出血患者160例,分保守治疗组、开颅治疗组和微创治疗组。采用单元、多元线性回归和方差分析分别研究血肿量与脑水肿量的相关性;不同部位及不同血肿量对脑水肿相对增量(relative growth of perihematomal edema volume,RE)的影响;手术与非手术对RE的影响进行比较。结果 高血压脑出血后血肿量与脑水肿发生呈正相关(r2=0.5831),与不同时间点RE相关(P<0.01);不同出血部位的RE间差异无统计学意义(P>0.05)。幕上出血中小血肿的RE最大(P<0.05);幕上微创组和开颅组间的RE差异无统计学意义(P>0.05),与保守治疗组相比,RE较少,差异有统计学意义(P<0.05);幕下开颅治疗组与保守治疗组相比,RE差异无统计学意义(P>0.05)。结论 高血压脑出血后血肿量与脑水肿程度、RE密切相关,幕上少量血肿对脑水肿变化速率影响较大,手术治疗在一定程度上减轻脑水肿发展速率。

Objective To investigate the effect of surgical intervention to brain edema formation and the development after hypertensive intracerebral hemorrhage（HICH）.Methods 160 patients with HICH were divided into conservative group（C group）,surgery group which includes craniotomy group（Sc group） and minimally invasive group（Sm group）.Simple linear regression,multiple linear regression and analysis of variance were used to study the correlation between the baseline volume of hematoma and the perihematomal edema volume,the effect of hematomato the relative growth of perihematomal edema volume（RE） with different bleeding sites,different volume and different time point.Analysis of variance was used to compare the effects of C group,Sc group and Sm group on RE at different time.Results There was a highly significant correlation between hematoma and perihematomal edema volumes at baseline（r2=0.583 1）,hematoma and RE at different time（P0.01）.There was no significant statistic difference of RE in different bleeding sites（P0.05）.The largest RE（P0.05） was the small supratentorial intracerebral hematoma.There was no significant difference of RE between Sc group and Sm group,but they were significantly lower compared with C group（P0.05）.There was no significantly difference between RE of C group and Sc group with infratentorial intracerebral Hemorrhage（P0.05）.Conclusion The degree of perihematomal edema and RE are strongly related to the size of the baseline hematoma of HICH.And a small quantity of supratentorial hematoma could largely impact the development of brain edema.Removing hematoma by surgery can reduce the development of brain edema.