血肿清除时机对高血压脑出血预后转归的影响

The effect of timing for hematoma removal to prognosis of hypertensive intracerebral hemorrhage

目的 探讨高血压脑出血不同手术时机对临床预后的影响.方法 本组125例高血压脑出血患者,按发病至手术开始的时间分组,8 h内（超早期组）38例,8～24 h内（早期组）46例,24 h后（晚期组）41例,分别对术后再出血发生率、神经功能恢复状态以及病死率进行比较.结果 超早期组术后再出血发生率高（P〈0.05）,超早期组功能恢复良好者多于早期组和晚期组（P〈0.05）;3组患者病死率差异无统计学意义 （P＞0.05）.结论 超早期手术清除血肿可降低术后神经功能缺陷,提高生存质量.可通过术中血压监测、有效止血、术后控制血压等综合治疗降低再出血发生率.

Objective To investigate the effects of different operation timing for hematoma removal on clinical prognosis of hypertensive intracerebral hemorrhage. Methods 125 patietns were divided into 3 groups,of which 38 patients were operated within 8 hours（ultra-early Group） ,46patiants were operated after 8 hours but within 24 hours（early group）and 41 patients were operated after 24hours（late group）. A comparative analysis of rebleeding incidence, recovery of neurological function and mor- tality were conducted. Results High post-operative rebleeding rate and better recovery appeared in ultra-early group （P〈 0.05） ,which superior to the other two group. Significant difference were not found in motality rate （P〉0.05）in three group. Conclusion Ultra-early surgical removal of the hematoma may reduce postoperative neurological deficit and improve thequality of patients ＇ life. Increasing blood pressure to find out bleeding vessel during operation and effective hemostasis , andeffective blood pressure control were beneficial factor to reduce rebleeding rate in ultra-early group.