不同时机和手术方式在高血压脑出血治疗中的应用与临床适用性研究

Application and clinical applicability of different timing and surgical methods in the treatment of hypertensive intracerebral hemorrhage

目的 研究不同时机及手术方式治疗高血压脑出血的临床效果,并分析其适用性。方法 选取2012年1月-2016年1月我院收治的301例高血压性脑出血患者作为研究对象,将其按照治疗时机（发病到入院接受治疗的时间）的不同分为三组,超早期治疗组（〈6 h）81例、早期治疗组（6-24 h）156例、晚期治疗组（〉24 h）64例;以患者的出血部位、出血量、血肿程度等为依据选择不同的手术方式分组,去骨瓣减压血肿清除术组92例、小骨窗开颅血肿清除术组121例、穿刺引流术组88例,比较不同时机和手术方式下患者的治疗效果。结果 超早期治疗组、早期治疗组及晚期治疗组患者的近期治疗优良率分别为77.8%、50.0%、35.9%,随访期预后良好率分别为72.8%、56.4%、31.2%,均有超早期治疗组优于早期治疗组及晚期治疗组,早期治疗组优于晚期治疗组,差异有统计学意义（P〈0.05）。去骨瓣减压血肿清除术组、小骨窗开颅血肿清除术组、穿刺引流术组的并发症发生率分别为40.2%、24.8%、10.2%,去骨瓣减压血肿清除术组最高,而穿刺引流术组最低,差异有统计学意义（P〈0.05）;再出血发生率分别为8.7%、7.4%、10.2%,差异无统计学意义（P〉0.05）。结论 对于符合手术条件的患者,尽早实施手术治疗可以有效改善其神经功能,获得良好的预后效果,而手术方式的选择则要综合考虑患者的患病情况、身体状态等,以降低并发症发生率、促进其预后生存质量的提高。

Objective To study the clinical effect of different timing and surgical methods in the treatment of hyperten-sive intracerebral hemorrhage and analyze its applicability.Methods From January 2012 to January 2016,301 patients with hypertensive intracerebral hemorrhage admitted into our hospital were selected as study objects and divided into three groups,super-early treatment group （〈6 h,n=81）,early treatment group （6-24 h;n=156）,and late treatment group （〉24 h;n=64） according to different timing （time from disease attack to hospitalization for treatment）.Based on the bleeding position,amount of hemorrhage and degree of hematoma during the treatment,different surgical methods groups were selected,there were 92,121,and 88 cases in decompressive hematoma evacuation group,small bone window cran- iotomy group and puncture drainage group.The therapeutic effects in different time and surgical methods were com- pared.Results The excellent rate in the supev-early treatment group,early treatment group and late treatment group was 77.8%,50.0% and 35.9% in a short term,and the rate of favorable prognosis during followed-up visits was 72.8%,56.4% and 31.2%,the rate in the super-early treatment group was superior to that in the early treatment group and the late treatment group,and the early treatment group was superior to that in the late treatment group with statistical difference （P〈0.05）.The incidence of complications decompressive hematoma evacuation group,small bone window craniotomy group and puncture drainage group was 40.2%,24.8%,and 10.2%.The incidence of complications in the decompressive hematoma evacuation group was the highest,and the incidence in the puncture drainage group was the lowest with sta-tistical difference after comParison （P〈0.05）.The incidence of rehaemorrhagia in these three groups was 8.7%,7.4%,and 10.2% respectively,which was not displayed significant difference （P〉0.05）.Conclusion For patients meeting the surgical procedures,early implementation of surgical treatment can effectively improve neurological function and obtain a good prognosis.The selection of surgical methods should comprehensively consider patients＇ disease condition and physical state in order to decrease the incidence of complications and promote the quality of life in prognosis.