手术时机对高血压脑出血患者临床疗效和预后的影响

Influence of operative time on clinical efficacy and prognosis of patients with hypertensive cerebral hemorrhage

目的探讨手术时机的选择对高血压脑出血患者临床疗效和预后的影响。方法选取2013年1月~2018年12月在我院接受治疗的高血压脑出血患者109例,按照手术时机不同分为A、B、C三组,三组均采用开颅血肿清除术,A组手术时间为出血后<7 h,B组手术时间为出血后≥7 h且≤24 h,C组手术时间为出血后>24 h,比较三组患者的临床效率、术后血肿和脑水肿体积及预后效果。结果 A组血肿清除总有效率为97.2%,明显高于B组的83.3%与C组的78.4%;C组术后血肿和脑水肿体积分别为(6.79±1.01)mL、(9.71±2.15)mL均大于A组(5.32±1.05)m L、(6.52±1.05)mL与B组(5.33±1.18)mL、(6.18±2.02)mL,组间差异有统计学意义(P<0.05);A组与B组患者2周后GOS评分与半年后Barthel指数均明显高于C组,差异有统计学意义(P<0.05)。结论高血压脑出血早期手术不仅可以有效提高临床治疗效果,同时也能有效减少患者术后出血量,缩小脑水肿体积,改善预后,促进患者早日康复。

Objective To investigate the influence of operative time on the clinical efficacy and prognosis of patients with hypertensive cerebral hemorrhage. Methods 109 patients with hypertensive cerebral hemorrhage treated in our hospital from January 2013 to December 2018 were divided into group A, group B, and group C according to different operative time. Clearance of hematoma by craniotomy was applied to all three groups. The operative time of group A was <7 h after hemorrhage, the operative time of group B was ≥7 h and ≤24 h after hemorrhage, and the operative time of group C was >24 h after hemorrhage. The clinical efficiency, volume of postoperative hematoma, volume of cerebral edema, and prognosis were compared among three groups. Results The total effective rate of hematoma removal in group A was 97.2%, which was significantly higher than that in group B(83.3%) and group C(78.4%);The volumes of postoperative hematoma and cerebral edema were larger in group C[(6.79±1.01)mL,(9.71±2.15)mL] than in group A[(5.32±1.05)mL,(6.52±1.05)mL] and group B[(5.33±1.18)mL,(6.18±2.02)mL]. The differences among groups were statistically significant(P<0.05). After 2 weeks, the GOS score and Barthel index of group A and group B were significantly higher than those of group C(P<0.05). Conclusion Early operation for hypertensive cerebral hemorrhage can not only improve clinical treatment effect, but also effectively reduce the amount of postoperative bleeding, reduce the volume of cerebral edema, improve the prognosis, and promote the early recovery of patients.