微创手术加超早期康复联合中医药干预高血压病脑出血患者的疗效观察

Clinical Observation of Minimally Invasive Surgery plus Ultra-early Rehabilitation Combined with Traditional Chinese Medicine Intervention for Patients with Intracerebral Hemorrhage

目的观察微创手术加超早期康复联合中医药干预高血压病脑出血的疗效。方法将126例高血压脑出血患者随机分为3组,A组(微创手术加超早期康复联合中医药干预组)41例(失访1例)、B组(微创手术加超早期康复组)40例(失访1例,自行退出1例)、C组(单纯微创手术组)42例。选择定向软通道手术方式,术后超早期康复训练,参照脑出血急性期中西医结合诊疗专家共识简化分型方法,用中医药干预治疗。治疗后比较3组疗效。选择日常生活活动(activities of daily living,ADL)能力和神经功能缺损程度评分评定近期疗效,采用格拉斯哥预后量表(GOS)评定远期疗效(总有效率和致残率)。结果各组治疗后较治疗前ADL评分升高(P<0.05,P<0.01),NIHSS评分降低(P<0.05,P<0.01)。各组治疗后ADL、NIHSS评分两两比较,差异均有统计学意义(P<0.05,P<0.01),且ADL评分A组>B组>C组,NIHSS评分A组<B组<C组。近期疗效:各组恢复良好率两两比较,差异有统计学意义(P<0.05,P<0.01),且A组>B组>C组。各组显著进步率、进步率、无效率、病死率及总有效率比较,差异无统计学意义(P>0.05)。远期疗效:优:A、B两组比较差异无统计学意义(P>0.05),C组低于A组和B组(P<0.05)。良:A组高于B组和C组(P<0.05);B组和C组比较差异无统计学意义(P>0.05)。各组的中与差比较,差异无统计学意义(P>0.05)。各组总有效率两两比较,差异有统计学意义(P<0.05,P<0.01),且A组>B组>C组。各组的致残率两两比较,差异有统计学意义(P<0.05,P<0.01),且A组<B组<C组。各组患者远期没有再出现死亡。结论微创手术加超早期康复可提高高血压病脑出血患者的疗效,联合中医药干预效果更显著。

Objective To observe the effect of minimally invasive surgery plus ultra-early rehabilitation combined with traditional Chinese medicine (TCM)intervention on patients with intracranial hemorrhage (ICH).Methods Totally 126 patients were randomly assigned to three groups.There were 41 cases in group A (minimally invasive surgery plus ultra-early rehabilitation combined with traditional Chinese medicine),40 cases in group B (minimally invasive surgery plus ultra-early rehabilitation),and 42 cases in group C (minimally invasive surgery alone).Oriented soft channel operation method was selected. Post-operative super-early rehabilitation training was performed.Typing methods were simplified referring to Experts'Consensus on Diagnosis and Treatment of ICH by Traditional Chinese Medicine and Western Medicine.TCM intervention was used.The efficacies were compared among the three groups after treatment.Activities of daily living (ADL)and neurologic deficit score were selected to assess short-term efficacy.Long-term efficacy was assessed using Glasgow Outcome Scale (GOS)(including the total effective rate and the disability rate),post-treatment.Results ADL score all increased more in each group after treatment than before treatment (P <0.05,P <0.01),and neurologic deficit score (NIHSS)decreased more after treatment (P <0.05,P <0.01).There was statistical difference in posttreatment ADL and NIHSS by multiple comparison (P <0.05,P <0.01).ADL score was sequenced as group A >group B >group C. NIHSS was sequenced as group A <group B <group C.As for short-term efficacy:good recovery effec- tive rate was statistically different among the three groups (P <0.05,P <0.01),and it was sequenced as group A >group B >group C.There was no statistical significant difference in significant progress rate, progress rate,ineffective rate,death rate,or total effective rate among the three groups (P >0.05).As for long-term efficacy.Excellent.There was no significant difference between group A and B (P >0.05),and group C was lower than group A and B (P <0.05).Good=Group A was higher than group B and C (P < 0.05)there was no significant difference between group B and C (P >0.05).There was no significant difference in the average and the poor data sets among all the groups.(P >0.05):There was statistical difference in the total effective rate by multiple comparison (P <0.05,P <0.01),and sequenced as group A >group B >group C.There was statistically significant difference in the disability rate after multiple com- parison between groups (P <0.05,P <0.01)and sequenced group A <group B <Group C.No further mortality appeared in all groups.Conclusion Minimally invasive surgery plus ultra-early rehabilitation could elevate the efficacy of ICH patients,and better effects could be obtained when combined with TCM intervention.