高血压性脑出血患者早期手术与预后的相关性评价

The Relationship of Early Surgical Treatment and Prognosis in Patients with Hypertensive Intracerebral Hemorrhage

目的颅内血肿体积在临床上可作为高血压性脑出血(ICH)急性期治疗方法选择和预后评价的重要参考指标,探讨非手术治疗和手术治疗对ICH早期预后的影响。方法回顾性分析291例幕上和幕下小脑出血患者的病史、临床指标和CT影像学资料。根据公式1/2ABC测量血肿的出血量,收集患者的美国国立卫生研究院卒中评分(NIHSS)、格拉斯哥昏迷评分(GCS)和国际颅内出血外科治疗试验应用的预后评估(STICH预后评估)评分结果,评价患者术后的早期预后。2P1例ICH患者中220例未行手术治疗(非手术治疗组),71例行手术治疗(手术治疗组)。应用STICH预后评估评分将所有病例分为预后良好(评分≥27.672分)和预后不良(评分<27.672分)。结果预后良好的ICH患者行早期手术治疗后的效果并不明显,与非手术治疗组相似(P=0.726);但预后不良中,早期进行手术治疗比非手术治疗患者或有一定的获益(P=0.004)。结论 STICH预后评估评分是一种简单有效的评估工具,根据评分有可能提示对预后不良的ICH患者采用手术治疗方案可更好地挽救患者生命,有利于早期神经功能的恢复。

Aim To analyze the relationship of non-surgical treatment or surgical treatment and early prognosis in patients with hypertensive intracerebral hemorrhage.The volume of intracranial hematoma can be used as an important reference index in the treatment of ICH in acute phase.Methods The medical history,medical data and the CT images of 291 patients with supratentorial or subtentorial hemorrhage were reviewed when they were hospitalized in Shanghai Minhang Hospital or Ruijin Hospital of Shanghai Jiaotong University or other three hospitals.The size of hematoma was measured according to the formula of 1/2ABC,and the National Institutes of Health Stroke Scale,GCS scores and the prediction scores from the studies of Surgical Trial in Intracerebral Haemorrhage of all patients were collected.And then the patients＇ early prognosis were hypothesized.Results According to the prediction score from the study of Surgical Trial in Intracerebral Haemorrhage all patients were divided into a better prognosis group（score≥27.672）and a poor prognosis group（score 27.672 分）.The result of early surgery in the better prognosis group was not obvious,and was similar to the group with non-surgical treatment（P=0.726）.But in the poor prognosis group of patients,early surgery group may have got some more benefit compared with the non-surgical goup（P=0.004）.Conclusion The prediction score from the study of Surgical Trial in Intracerebral Haemorrhage is a simple and effective evaluation tool.Early surgery treatment may be better to save lives and help their neurological repair earlier than non-operative treatment in poor prognosis group.