高血压脑出血患者不同手术时机治疗与术后发生再出血及近期疗效的关系研究

Relationship between timing of surgical intervention and postoperative recurrent hemorrhage and short-term efficacy in patients with hypertensive intracerebral hemorrhage

目的探讨高血压脑出血患者不同手术时机治疗与术后发生再出血及近期疗效的关系。方法回顾性分析2008年1月—2013年6月浙江省杭州市萧山区第一人民医院神经外科手术治疗的260例高血压脑出血患者的临床资料，根据发病至手术时间的不同将患者分为超早期组（≤6h）74例，早期组（6～24h）124例及晚期组（≥24h）62例，比较3组患者术后再出血及近期疗效的差异。结果本研究260例高血压脑出血患者中发生再出血33例，再出血发生率为12．69％，超早期组发生率为21．62％，早期组发生率为10．48％，晚期组发生率为3．13％，超早期组再出血发生率明显高于早期组与晚期组，差异有统计学意义（P〈0．05），早期组与晚期组无明显差异（P〉0．05）；超早期组优良率为22．97％，病死率为21．62％；早期组优良率为27．42％，病死率为18．55％，晚期组优良率为20．96％，病死率为17．74％，3组间优良率及病死率两两比较差异无统计学意义（P〉0．05）。结论超早期手术治疗高血压脑出血虽然可迅速清除血肿，解除对脑组织的压迫、尽可能恢复神经元功能，但是同时应意识到超早期手术与术后再出血的关系，早期手术对于符合条件的患者是较为安全且有效的手术时机。

Objective To investigate the relationship between the timing of surgical intervention and postoperative recur- rent hemorrhage and short-term efficacy in patients with hypertensive intracerebral hemorrhage. Methods The clinical data of 260 patients with hypertensive intracerebral hemorrhage were analyzed retrospectively. The patients were divided into 3 groups according to the timing of surgical intervention,74 cases uhra-early group（ 〈6 h）, 124 cases in early group （6 -24 h）, and 62 cases in late group（/〉24 h）. The rate of postoperative rebleeding and short-term effect were compared among the three groups. Results There were 33 cases of recurrent hemorrhage with a rate of 12.69% ,21.62% in the ul- tra-early group, 10.48% in the early group, and 3.13 in the late group, the difference in the rate of rebleeding between the ultra-early group and the other two groups was statistically significant（P 〈 0.05 ）, there was no significant difference be- tween the early group and the late group（P 〉0.05）. The excellent rate was 22.97% ,27.42% and 20.96% in the ultra- early group, early group and late group,respectively;while the mortality rate was 21.62%, 18.55% and 17.74% the ul- tra-early group, early group and late group, respectively, no significant difference was found between any two group （ P 〉 0.05）. Conclusion The ultra-early surgical treatment can quickly remove the hematoma, relieve the oppression on the brain tissue, as far as possible to restore neuronal function, but may also increase the risk of rebleeding. The early time of surgery is safer and effective only for the eligible patients.