锁孔术治疗高血压性脑出血的效果及预后影响因素分析

Efficacy of keyhole hematoma debridement for hypertensive intracerebral hemorrhage and related factors of prognosis

目的分析锁孔术治疗高血压性脑出血(HICH)的效果及预后影响因素。方法抽取平顶山第一人民医院2016年6月至2019年12月收治的HICH患者90例,采用HICH锁孔术治疗。统计患者的性别、年龄、手术时机、术中出血量、脑血肿部位、瞳孔散大情况、格拉斯哥昏迷指数(GCS)评分、并发症发生情况、预后情况。采用日常生活活动(ADL)分级法评价预后。分析影响预后的相关因素。结果90例HICH患者中预后良好者74例,预后不良者16例。年龄、出血量、出血部位、瞳孔散大、手术时机、GCS评分、并发症是影响HICH锁孔术预后的单因素(P<0.05)。>70岁、出血量>60 ml、内囊后肢型、双侧瞳孔、延期手术、GCS评分≤5分、2种及以上并发症是HICH锁孔术预后的独立危险因素(P<0.05)。结论HICH锁孔术的疗效较好,年龄、脑出血量是影响预后的独立危险因素,术前要严格掌握适应证,提升临床疗效。

Objective To investigate the efficacy of keyhole hematoma debridement in the treatment of hypertensive intracerebral hemorrhage(HICH),and to analyze related factors of prognosis.Methods A total of 90 HICH patients who were hospitalized in Pingdingshan First People’s Hospital from June 2016 to December 2019 were enrolled.All patients were treated by keyhole hematoma debridement.The data including gender,age,operation timing,blood loss,hemorrhage locations,mydriasis,Glasgow Coma Scale(GCS)scores,incidence of complications,prognosis of these patients were collected.The prognosis was evaluated by activities of daily living scale.And the related factors of prognosis were analyzed.Results Among the 90 patients,74 patients had good prognoses,while 16 patients had poor prognoses.Age,blood loss,hemorrhage locations,mydriasis,operation timing,GCS score and complications were the single factors affecting the prognosis of HICH patients after keyhole hematoma debridement(P<0.05).Age>70 years,blood loss>60 ml,internal capsular posterior limb hemorrhage,bilateral mydriasis,delayed surgery,GCS score≤5,and complications≥2 types were independent risk factors affecting the prognosis of HICH patients after keyhole hematoma debridement(P<0.05).Conclusions Keyhole hematoma debridement has a good clinical effect for HICH patients,while the age and blood loss are independent risk factors of prognosis.Therefore,strict control of indications before surgery is of great significance for clinical efficacy.