高血压脑出血患者不同时机手术对神经功能康复的影响

Analysis of optimal operation time window for patients with HICH and its effect on rehabilitation of neurological function

目的探讨高血压脑出血(HICH)患者选择不同时机手术的临床效果。方法选取2017-01—2019-08在平顶山市第一人民医院治疗的HICH患者87例,均行微创血肿穿刺术,根据发病至手术时间将患者分为≤6 h组、>6~24 h组和>24 h组,观察各组再出血、病死率以及术后生存质量。结果≤6 h组肺部感染率为8.33%,明显低于>6~24 h组和>24 h组(P<0.05);各组再出血、病死率、肾衰竭和应激性溃疡比例比较差异无统计学意义(P>0.05);≤6 h组日常生活能力(ADL)分级明显优于>6~24 h组和>24 h组(P<0.05);>6~24 h组和>24 h组ADL分级比较差异无统计学意义(P<0.05);≤6 h组WHO生存质量评估简表(WHOQOL-BRFF)评分为(76.55±8.21)分,明显高于>6~24 h组和>24 h组(P<0.05);>6~24 h组WHOQOL-BREF评分为(70.12±9.10)分,明显高于和>24 h组(P<0.05)。结论HICH患者早期(尤其发病至手术时间≤6 h)行手术治疗有助于患者神经功能恢复和生活质量的提高。

Objective To investigate the clinical effect of different operative timing in patients with hypertensive intracerebral hemorrhage(HICH).Methods From January 2017 to August 2020,87 patients with HICH were treated by minimally invasive hematoma puncture,patients were divided into≤6 h group,>6-24 h group and>24 h group according to onset to operation time,the rebleeding,mortality and postoperative quality of life and so on were observed.Results The rate of lung infection in≤6 h group was 8.33%,significantly lower than that in>6-24 h group and>24 h group(P<0.05).There were no significant difference in rebleeding,mortality,renal failure and stress ulcer in each group(P>0.05).The grade of daily living ability(ADL)in≤6 h group were significantly better than that of>6-24 h group and>24 h group(P<0.05).There was no statistical difference in ADL between>6-24 h group and>24 h group(P<0.05).The score of World Health Organization quality life-BREF(WHOQOL-BRFF)in≤6 h group was(76.55±8.21),which was significantly higher than that in>6-24 h group and>24 h group(P<0.05).The WHOQOL-BREF score of>6-24 h group was(70.12±9.10),which was significantly higher than that of>24 h group(P<0.05).Conclusion Surgical treatment is performed in early stage of HICH(especially onset to operation time≤6 h)can help patients recover their neurological function and improve their quality of life.