小骨窗显微手术治疗基底节区高血压性脑出血的手术时机探讨

Study on optimal timing for treatment of moderate amount of hypertensive basal ganglia cerebral hemorrhage by using small skull window microsurgery

目的：探讨小骨窗显微手术治疗基底节区高血压性脑出血手术时间与预后的关系，寻求其最佳手术治疗时间窗。方法100例高血压脑出血患者随机抽签筛选出60例作为研究对象，并将其随机分为三组，每组20例。分别为超早期手术组（＜7 h），早期手术组（7~12 h内），延期手术组（12 h以后）。三组均实施小骨窗显微手术治疗。观察三组患者住院期间的再出血率、病死率及术后6个月日常生活自理能力。结果①再出血率：超早期、早期和延期手术组再出血率分别为15.0％、35.0％和80.0％，延期手术组显著高于其他两组（ P ＜0.001，P ＜0.01）。②病死率：超早期、早期和延期手术组再出血率分别为15.0％、40.0％和60.0％，延期手术组显著高于超早期手术组（ P ＜0.01）。③术后6个月日常生活能力：越早手术，生活质量越好，但三组间未达统计学差异。结论出血后7h内手术是小骨窗显微手术治疗基底节区高血压性脑出血的最佳手术时间窗。

Objective To explore the outcome of different timing for microsurgery through small skull window for treatment of patients with hypertensive basal ganglia cerebral hemorrhage. Methods Sixty of 100 patients with hypertensive intracranial hemorrhage admitted in this hospital were randomly divided into three groups,ultra-early group（within 7 hours）,early group（7 to 12 hours）and postponed operation group（over 12 hours）. Small skull window microsurgery had been applied in all 85 cases. The incidence of re-bleeding,mortality and activities of daily living were evaluated in each group. Results The incidence rates of re-bleeding in ultra-early group,early group,and postponed operation group were 15. 0%,35. 0% and 80. 0% respectively,while the latter was obviously higher than the former two groups（ P 〈0. 001,P 〈0. 01）. The mortality was 15. 0% in ultra-early group,40. 0% in early group,and 60. 0% in postponed operation group,and it in postponed operation group was significantly higher than that of ultra-early group（ P 〈0. 01）. The quality of life was better in patients received earlier operation,but there was no notable alteration among three groups. Conclusion The optimal timing for removal of basal ganglia hematoma by using small skull window microsurgery is within 7 hours after the onset of hemorrhage.