高血压脑出血患者的手术治疗:手术时机与预后(英文)

Hypertensive intracerebral hemorrhage:surgical timing and prognosis

目的探讨超早期和早期手术对老年组和中年组高血压脑出血（ICH）患者预后的影响。方法高血压脑出血患者分为老年组（60～83岁，57例）和中年组（39～59岁，46例）。老年组中26位患者（45．6％）及中年组中22位患者（47．8％）行超早期手术治疗（发病7h内）；而老年组中31位患者（54．4％）及中年组中24位患者（52．2％）则接受了早期手术治疗（发病7．48h）。术后通过日常生活能力评分表（ADL）对患者的预后进行χ^2分析及评价。结果在老年组患者中，超早期手术的病死率较早期手术低（7．0％VS32．2％，χ^3=5．134，P〈0．05）。经超早期手术的患者中ADL评分为Ⅰ级的为12人，明显高于经早期手术的6人（46．1％vs19．3％，χ^2=4．7，P〈0．05）。尽管如此，在中年组患者中，超早期和早期手术的预后无明显差别。结论对于老年高血压脑出血患者，与早期手术相比，超早期手术可获得更好的预后。但此结论不适于中年高血压脑出血患者。

Objective To investigate the effect of ultra-early or early surgical treatment on the aged and middle-aged patients with hypertensive intracerebral hemorrhage （ICH）. Methods Patients with hypertensive ICH were classified into the aged （range from 60 to 83 years old, 57 cases） and middle-aged （range from 39 to 59 years old, 46 cases） groups. Of 103 patients, 26 （45.6%） in the aged group and 22 （47.8%） in the middle-aged group underwent ultra-early surgical treatment （within 7 h）, while 31 （54.4%） in the aged group and 24 （52.2%） in the middle-aged group were treated by early surgical management （within 7-48 h）. The activity of daily living （ADL） measure was used to assess the outcome of patients with hypertensive ICH after surgery. Results Mortality in the aged group was significant lower after ultra-early surgical treatment compared with early surgical treatment （7.0% vs 32.2%, χ^2 = 5.134, P〈 0.05）. In addition, in the aged group 12 patients after ultra-early surgery and 6 patients after early surgery were in ADL grade Ⅰ （46.1% vs 19.3%, χ^2 = 4.7, P 〈 0.05）. However, there was no statistically significant difference in outcome in the middle-aged group after uhra-early compared with that after early surgical treatment （all P 〉 0.05）. Conclusion Ultra-early surgical treatment can bring on a better outcome for aged but not for middle-aged patients with hypertensive ICH in comparison to early surgical treatment.