高血压脑出血最佳微创手术时机研究

Study on the optimal minimally invasive surgery time on hypertensive intracerebral hemorrhage

目的通过比较高血压脑出血不同微创手术时机的疗效,探讨最佳手术时机。方法将160例高血压脑出血手术病例按发病到手术时间分为超早期（〈6 h）、早期（6~12 h）和迟早期（12~24 h）3组,分别进行术后并发症、治疗14 d时神经功能缺损程度、近期疗效和远期疗效比较。结果①超早期组中有19例（29.23%）出现术后再出血,高于其他两组。超早期手术死亡率高于其他两组,超早期与早期组的死亡率有显著性差异;②迟早期组中恢复良好18例（40.0%）,中残12例（26.7%）,重残8例（17.8%）,植物生存4例（8.8%）,死亡3例（6.7%）。其近期疗效差于另两组;③治疗14 d神经功能状况比较,早期组比其他两组轻度神经功能缺失者明显增多,重度神经功能缺失者明显减少;④3组间远期疗效无明显差异。结论手术时机在早期比较理想,手术疗效较好。

【Objective】To explore the optimal time course for surgery of hypertensive intracerebral hemorrhage（HICH） by comparing the outcome of treatment of different minimal invasive surgery time. 【Methods】According to the time course of surgery, 160 cases of HICH were divided into 3 groups which were super early group（6 h）, early group（6~12 h） and delayed early group（12~24 h）. The postoperative complications, neuronal deficits in 14 day, nearterm outcome and long-term outcome were compared respectively.【Results】19（29.23%） patients with hematoma recurrence in super early group. Mortality and hematoma recurrence were higher than other two groups, there is statistical difference between super early group and early group; In delayed early group, 18 cases（40.0%） got well, 12 cases（26.7%） were moderate deformity, 8 cases（17.8%） were severe disability. 4 cases（8.8%） were vegetative state, 3 cases（6.7%） were dead. The near-term outcome was worse than other two groups; The mild neuronal deficits was more, and the severe neuronal deficits was less in early group; For the long-term outcome there was no significant difference among three groups.【Conclusions】The most optimal course for operation of HICH is the early group（6~ 12 h）.