高血压脑出血最佳手术时间临床研究

Clinical study on the best surgery time of hypertensive intracerebral hemorrhage

目的探讨高血压脑出血患者的最佳手术时间。方法将105例高血压脑出血患者按照发病到开始手术的时间不同分为超早期组(6 h之内)43例、早期组(6～24 h)37例、延迟组(超过24 h)25例。观察各组患者术后3 d内意识恢复情况及术后并发症及临床疗效等。结果超早期组3 d意识好转率明显高于其他2组(P均<0.05),而早期组与延迟组比较无显著性差异。超早期组术后再出血发生率虽高于其他2组,但组间两两比较无显著性差异。3组肺部感染、应激性溃疡和肾衰竭发生率两两比较均有显著性差异(P均<0.05)。超早期组恢复良好率、中度及重度残疾率与其他2组比较均有显著性差异(P均<0.05)。结论在稳定患者生命体征的情况下,超早期手术有利于促进高血压脑出血患者脑功能恢复,提高患者的生存质量。

Objective It is to explore the best surgery time of hypertensive intracerebral hemorrhage. Methods 105 cases of patients with hypertensive intracerebral hemorrhage were divided into ultra-early stage group（ within 6 h） with 43 case, early group （6 -24 h） with 37 eases and delay （more than 24 h） group according to the time from the disease attack to beginning surgery. The recovery of consciousness within 3 d and complications after operation and clinical curative effect in every group were observed. Results The improvement rate of consciousness within 3 d was obviously higher in ultra-early stage group than that in the other two groups（ P 〈 0.05 ） , but no significant difference in the rate was found between early stage group and delay group. Although the occurrence rate of recurrent hemorrhage after operation in ultra-early stage group was higher than that of the other two groups, but the differences were not significant compared with each other. The differences in the occurrence rates of lung infection, stress ulcer and renal failure were significant compared with each other （ P 〈 0.05）. Well recovery rate and moderate or serious disability rates in ultra-early stage group was better than that in the other two groups （ P 〈 0.05 ）. Conclu- sion Surgery in ultra-early stage is conducive to promoting the recovery of brain function and improving the survival quality of the patients when their body sign were stable.