阶梯性降压联合微创钻孔血肿引流术治疗高血压脑出血疗效观察

Observation of the Curative Effect of Ladder-like Anti-hypertension Combined with Minimally Invasive Trepanation and Drainage in the Treatment of Hypertensive Cerebral Hemorrhage at Different Treatment Time-window

目的研究不同治疗时间窗阶梯性降压联合微创钻孔血肿引流术治疗高血压脑出血的疗效。方法选取2014年6月至2017年6月于我院治疗的高血压脑出血患者224例,按数字表法随机分为A组155例、B组69例。所有患者均实施微创钻孔血肿引流术,在此基础上,A组接受阶梯性降压治疗,并按治疗时间窗的不同分为A1、A2亚组,B组则按照指南接受强效降压治疗。对比3组神经功能缺损评分情况、再出血率及病死率。结果 3组经治疗后神经功能缺损评分均明显下降,且差值相比,有统计学意义(P<0.05);A1、A2亚组及A2、B组差值两两相比,有统计学意义(P<0.05);3组再出血率、病死率相比,差异有统计学意义(P<0.05);A2、B组再出血率、病死率差异相比,统计学上有意义(P<0.05)。结论在高血压脑出血患者发病6 h内行阶梯性降压联合微创钻孔血肿引流术进行治疗可有效减少患者再出血率,改善其神经功能缺损情况,应用效果显著。

Objective To study and analyze the curative effect of ladder-like anti-hypertension combined with minimally invasive trepanation and drainage in the treatment of hypertensive cerebral hemorrhage at different treatment time-window. Methods 224 patients of hypertensive cerebral hemorrhage in intensive care unit（ ICU） from June 2014 to June 2017 were selected and randomly divided into group A（ 155 cases） and group B（ 69 cases）. Minimally invasive trepanation and drainage was performed on all of the patients. Patients in group A were also treated by ladder-like anti-hypertension and divided into subgroup A1 and subgroup A2 according to treatment time-window. Patients in group B were treated with potent anti-hypertension. Neurologic impairment scores,rebleeding rate and fatality rate of the three groups were compared. Results After treatment,the neurological deficit scores of the three groups were significantly decreased,and the difference was statistically significant（ P 〈 0. 05）,the difference between A1 and A2 subgroups and the difference between A2 and group B were statistically significant（ P 〈 0. 05）,the difference of the rebleeding rate,mortality rate of the three groups was statistically significant（ P 〈 0. 05）,the difference of rebleeding rate and mortality rate between A2 and group B was statistically significant（ P 〈 0. 05）. Conclusion Ladder-like anti-hypertension combined with minimally invasive trepanation and drainage within 6 h after onset can reduce rebleeding rate,improve neurological impairment,and reduce fatality rate of hypertensive cerebral hemorrhage.