不同手术时机和方式在高血压脑出血患者血肿清除中的效果

Effects of different surgical approaches and timing on hematoma removal of patients with hypertensive cerebral hemorrhage

目的分析不同手术时机和方式在高血压脑出血患者血肿清除中的效果。方法选择130例高血压脑出血患者,按照发病至手术时间将其分为A、B组。A组为出血后≤6 h给予手术治疗,B组为出血后>6h给予手术治疗。根据出血具体部位、血肿量、出血量大小进行手术分类,将其分为小骨窗开颅血肿清除术组和大骨瓣开颅血肿清除术组。观察并比较不同时机及不同方式患者的各项评分及ADL分级情况。结果 A组患者的MMSE评分、CSS评分及NIHSS评分均显著优于B组(P<0.05);小骨窗开颅组患者的MMSE评分、CSS评分及NIHSS评分均显著优于大骨瓣开颅组(P<0.05);A组患者的GCS评分以及肺部感染发生率显著优于B组(P<0.05);小骨窗开颅组的GCS评分显著高于大骨瓣开颅组(P<0.05);小骨窗开颅组的感染发生率稍高于大骨瓣开颅组;A组患者的Ⅰ级、Ⅱ级、Ⅳ级发生率均显著优于B组(P<0.05);小骨窗开颅组与大骨瓣开颅组的ADL分级情况基本相符。结论根据高血压脑出血患者的各项参数,尽早地行合适的手术方式治疗,可以提高其临床效果,降低其死亡率,适合临床长期推广应用。

Objective To analyze the effects of different surgical approaches and timing on hematoma removal of patients with hypertensive cerebral hemorrhage. Methods A total of 130 hypertensive cerebral hemorrhage patients were selected and they were divided into group A and group B according to the length of time from onset to surgery. The group A was given surgery within 6 hours after bleeding,while the group B was given surgery over 6 hours after bleeding. According to the exact location of the bleeding,hematoma and bleeding surgery size classification,these patients were divided into small bone window craniotomy group and large trauma craniotomy group. Scores of items and ADL grade among the patients with different timing and surgical approaches were compared. Results MMSE scores,CSS score and NIHSS scores in the group A were significantly better than those in the group B（ P〈0. 05）. MMSE scores,CSS and NIHSS score scores in the small craniotomy group were significantly better than those in the large craniotomy group（ P〈0. 05）. GCS scores and the incidence rate of lung infections in the group A were significantly higher than those in the group B（ P〈0. 05）.GCS score of the small craniotomy group was significantly higher than that in the large craniotomy group（ P〈0. 05）. The infection rate of the small craniotomy group was slightly higher than that in the large craniotomy group（ P〈0. 05）. Incidence rates of patients with grade Ⅰ,grade Ⅱ and gradeⅣ in the group A were significantly better than those in the group B（ P〈0. 05）. There was no significant difference in ADL grading condition between the small craniotomy group and the large craniotomy group. Conclusion According to the various parameters of patients with hypertensive cerebral hemorrhage,application of surgical treatment as soon as possible can improve the clinical effect and reduce the mortality rate,so it is suitable for long- term clinical application.