不同手术时机治疗高血压脑出血的临床效果对比

Comparison on the clinical effect of treatment for hypertensive cerebral hemorrhage at different operation opportunities

目的比较不同手术时机治疗高血压脑出血的临床效果。方法回顾性分析2013年5月~2016年5月陕西省渭南市中心医院神经外科收治的95例高血压脑出血患者的临床资料,所有患者均采用颅内血肿穿刺引流术进行治疗。按照手术时间的不同共分为三组:超早期组24例,出血到手术时间<6 h;早期组39例,出血到手术时间6~12 h;晚期组32例,出血到手术时间>12 h。比较三组患者的术后72 h再出血发生率和术后1年的预后、生存质量情况。结果早期组术后再出血发生率(15.4%)明显低于超早期组(58.3%)和晚期组(56.3%),差异均有统计学意义(P<0.05)。术后随访1年,早期组格拉斯哥预后评分(GOS)等级明显优于超早期组和晚期组(P<0.05);三组患者世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分均较术前明显提高(P<0.05),且早期组WHOQOL-BREF评分显著高于超早期组和晚期组,差异有统计学意义(P<0.05)。结论高血压脑出血患者于出血后6~12 h内进行手术,可明显降低再出血发生率,改善患者生存质量,具有良好的临床应用价值。

Objective To compare the clinical effect of treatment for hypertensive cerebral hemorrhage at different operation opportunities. Methods The clinical data of 95 cases of patients with hypertensive cerebral hemorrhage admitted to Department of Neurosurgery, Weinan Central Hospital from May 2013 to May 2016 was analyzed retrospectively. All patients were treated with intracranial hematoma puncture drainage and they were divided into three groups according to different operation time： ultra-early group（24 cases）, the time from bleeding to surgery was 6 h; early group（39 cases）,the time from bleeding to surgery was 6-12 h; late group（32 cases）, the time from bleeding to surgery was 12 h. The incidence of rehaemorrhagia after operation for 72 h and the conditions of prognosis and quality of life after operation for1 year in the three groups were compared. Results The incidence of rehaemorrhagia after operation in early group（15.4%）was lower than that of ultra-early group（58.3%） and late group（56.3%）, the differences were statistically significant（P〈0.05）. Followed up for one year after operation, the grading of Glasgow outcome score（GOS） in early group was significantly better than that of ultra-early group and late group（P〈0.05）; the scores of World Health Organization quality of life questionnaire（WHOQOL-BREF） in the three groups were all higher than those before operation（P〈0.05）, and the score of WHOQOL-BREF in early group was significantly higher than that of ultra-early group and late group, the differences were statistically significant（P〈0.05）. Conclusion For patients with hypertensive cerebral hemorrhage, the operation within 6-12 h after bleeding can obviously decrease the incidence of rehaemorrhagia, improve the quality of life, which has good clinical application value.