影响手术治疗高血压脑出血预后的相关因素分析(附168例报告)

Analysis of factors related to prognoses in patients with hypertensive cerebral hemorrhage undergoing surgery(report of 168 cases)

目的探讨影响手术治疗高血压脑出血患者预后的因素。方法 2004年12月至2011年2月手术治疗高血压脑出血病人168例,其中锥颅血肿碎吸或钻孔引流术43例,小骨窗开颅血肿清除术63例,传统开颅血肿清除术62例;超早期(发病后6h内)手术82例,早期(发病后6～24h)手术86例。分析影响术后1个月死亡率(近期预后)和术后6个月(远期)预后(按日常生活能力分级评估)的因素。结果入院时GCS评分、脑疝及手术时机等因素对近期预后有显著影响(P<0.05),脑疝及未超早期手术是近期死亡的危险因素;脑疝、手术时机及手术方式对远期预后有显著影响(P<0.05)。结论超早期进行小骨窗开颅血肿清除术及积极处理并发症有助于降低高血压脑出血患者的死亡率,改善其预后。

Objective To explore the factors related to prognoses in the patients with hypertensive cerebral hemorrhage （HCH） undergoing surgery. Methods The clinical data of 168 patients with HCH, who underwent surgery in our hospital December 2004 to February, 2011, were analyzed retrospectively. Of 168 patients with HCH, 43 underwent aspiration or drainage through puncture, 63 evacuation of hematomas through small craniotomy and 62 routine evacuation of hematomas. The surgery were performed within 6 hours after the hemorrhage in 82 patients and 6N24 hours after the hemorrhage in 86 patients. The factors related to the short-term prognosis （mortality 1 month after the operation） and long-term pragnosis assessed according to activities of daily living 6 months after the opeartion were analyzed. Results The factors related to the short-term prognosis included GCS on admission into hospital, cerebral hernia and operative opportunity （P〈0.05）. The risk factors related to short-term death included cerebral hernia, operative opportunity （more than 6 hours after the hemorrhage）. The factors related to long-term prognosis included cerebral hernia, operative opportunity and operative way （P〈0.05）. Conclusion The evaculation of hematomas completed by the ultra-early small craniotomy and positive treatment of the postoperative complications are helpful to decreasing the mortality and improving prognosis in the patients with HCH.