中等量高血压性脑出血不同治疗手段的临床疗效比较

Clinical curative effect comparison of different treatments on moderate hypertensive cerebral hemorrhage

目的比较保守治疗、微创颅内清除术和开颅手术治疗中等量高血压性脑出血的疗效。方法收集符合纳入标准的出血量约30-50 m L的高血压性脑出血患者71例,根据患者及家属意愿分为三组,分别给予保守治疗,微创治疗及开颅手术治疗。比较三组患者治疗7d、14d及28d神经功能恢复的情况,治疗1个月的临床疗效及6个月的日常生活能力（ADL）。结果治疗7d和14d,微创组评分低于保守组及手术组（P〈0.05）,手术组评分低于保守组（P〈0.05）;治疗28d,微创组评分低于保守组（P〈0.05）。治疗1个月微创组总有效率为65.2%,手术组总有效率为62.5%,均高于保守组的25.0%;微创组死亡率30.4%,手术组死亡率为33.3%,均低于保守组的66.7%,P均〈0.05,差异有统计学意义。治疗6个月保守组ADL分级I-II级1例,III-V级6例。微创组I-II级13例,III-V级3例。手术组I-II级5例,III-V级10例。微创组与保守组、微创组与手术组相比,差异均有统计学意义（P〈0.05）。结论微创术后患者存活率高,短期神经功能恢复快,长期独立生活能力优于手术组和保守组,是30-50mL高血压性脑出血治疗的首选。

Objective To compare the clinical efficacy of conservative treatment,minimally invasive treatment and surgical treatment on hypertensive cerebral hemorrhage. Methods Seventy-one cases were collected in accordance with the inclusive criteria and were divided according to their wills into three groups,separately receiving conservative treatment,minimally invasive treatment and surgical treatment. Neural function recovery of each group was compared on the post-treatment 7th day,14 th day and 28 th day. Clinical curative effect of three groups after 1 month treatment and long-term prognosis of each group were studied. Results Neural functional deficit scores during different periods were compared. On the 7th and 14 th day,the scores of minimally invasive group were lower than conservative group and surgery group（ P〈 0. 05）,the score of surgery group was lower than conservative group（ P 〈0. 05）. On the 28 th day,the score of minimally invasive group was obviously lower than conservative group（P〈0.01）. After treatment of 1 month,the total effective rate of conservative group was 25. 0%,mortality rate 66. 7%,the total effective rate of minimally invasive group was65.2% and mortality rate 30.4%,the total effective rate of surgery group was 62. 5% and mortality rate 33.3%. In comparison of ADL grade after 6 months,conservative group had 1 case in grade I-II and 6 cases in grade III-V,minimally invasive group had 13 cases in grade I-II and 3 cases in grade III-V,surgery group had 5 cases in grade I-II and10 cases in grade III-V. There were significant differences between conservative group and minimally invasive group（ P〈0. 01）,surgery group and minimally invasive group（ P〈0.05）. Conclusions Minimally invasive treatment has high effective rate,the best short-term neural functional recovery and long-term independent living,and shows greatcurative effect in treating hypertensive cerebral hemorrhage in the amount of 30-50mL.