不同时间窗经额血肿穿刺引流高血压脑出血患者预后比较

Comparison of the prognosis of patients with hypertensive cerebral hemorrhage underwent transfrontal puncture and drainage at different time windows

目的比较不同时间窗经额血肿穿刺引流高血压脑出血(HCH)患者的预后。方法选择2017年1月至2019年12月安徽省第二人民医院收治的63例HCH患者为研究对象,所有患者行体位辅助经额血肿穿刺引流术,根据发病至穿刺术的时间将患者分为超早期手术组25例(脑出血时间≤6 h)、早期手术组28例(脑出血时间>6~24 h)和延迟手术组10例(脑出血时间>24 h)。比较3组患者术后1周内再出血率、病死率和并发症发生率;分别于术前和术后2周对3组患者进行格拉斯哥预后评分(GOS),术后3个月时采用Barthel指数评估患者日常生活活动(ADL)能力。结果术后1周内,超早期手术组患者再出血率、并发症发生率和病死率分别为8.00%(2/25)、4.00%(1/25)、4.00%(1/25),早期手术组患者再出血率、并发症发生率和病死率分别为7.14%(2/28)、25.00%(7/28)、17.86%(5/28),延期手术组患者再出血率、并发症发生率和病死率分别为10.00%(1/10)、30.00%(3/10)、30.00%(3/10);3组患者术后1周内再出血率比较差异均无统计学意义(P>0.05),超早期手术组患者并发症发生率、病死率显著低于早期手术组和延迟手术组(P<0.05),早期手术组与延迟手术组患者并发症发生率、病死率比较差异无统计学意义(P>0.05)。术前3组患者GOS评分比较差异无统计学意义(P>0.05),3组患者术后2周时GOS评分均显著高于术前(P<0.05);术后2周,超早期手术组和早期手术组患者GOS评分显著高于延迟手术组(P<0.05),超早期手术组患者GOS评分显著高于早期手术组(P<0.05)。超早期手术组、早期手术组和延迟手术组患者术后3个月时ADL评分分别为(73.5±2.2)、(65.4±3.6)、(63.7±3.3)分;超早期手术组患者ADL评分显著高于早期手术组和延迟手术组(P<0.05),早期手术组与延迟手术组患者ADL评分比较差异无统计学意义(P>0.05)。结论超早期经额血肿穿刺引可以显著降低HCH患者的并发症发生率和病死率,改善患者预后,提高患者的生活自理能力。

Objective To compare the prognosis of patients with hypertensive cerebral hemorrhage(HCH)underwent transfrontal puncture and drainage at different time windows.Methods Sixty-three patients with HCH treated in Anhui No.2 Provincial People′s Hospital from January 2017 to December 2019 were selected as the research subjects.All patients underwent transfrontal puncture and drainage,and the patients were divided into super-early operation group(cerebral hemorrhage time≤6 h,n=25),early operation group(cerebral hemorrhage time>6-24 h,n=28)and delayed operation group(cerebral hemorrhage time>24 h,n=10)according to the time from onset to puncture.The rebleeding rate,fatality rate and the incidence of complications within one week after operation were compared among the three groups.The patients were performed with Glasgow outcome scale(GOS)before and two weeks after operation.The activity of daily living(ADL)of patients was evaluated by Barthel index at 3 months after operation.Results Within one week after operation,the rebleeding rate,the incidence of complications and fatality rate in the super-early operation group were 8.00%(2/25),4.00%(1/25)and 4.00%(1/25),respectively;and they were 7.14%(2/28),25.00%(7/28)and 17.86%(5/28)respectively in the early operation group;while they were 10.00%(1/10),30.00%(3/10)and 30.00%(3/10)respectively in the delayed operation group.There was no significant difference in the rebleeding rate within one week after operation among the three groups(P>0.05).The incidence of complications and fatality rate in the super-early operation group were significantly lower than those in the early operation group and the delayed operation group(P<0.05),but there was no significant difference in the incidence of complications and fatality rate between the early operation group and the delayed operation group(P>0.05).There was no significant difference in GOS score among the three groups before operation(P>0.05).The GOS score at two weeks after operation was significantly higher than that before operation in the three groups(P<0.05).At two weeks after operation,the GOS score of patients in the super-early operation group and early operation group was significantly higher than that in the delayed operation group(P<0.05),and the GOS score of patients in the super-early operation group was significantly higher than that in the early operation group(P<0.05).The ADL score at three months after operation in the super-early operation group,early operation group and delayed operation group was 73.5±2.2,65.4±3.6 and 63.7±3.3,respectively.The ADL score of patients in the super-early operation group was significantly higher than that in the early operation group and delayed operation group(P<0.05),but there was no significant difference in ADL score between the early operation group and delayed operation group(P>0.05).Conclusion Super-early transfrontal puncture and drainage can significantly reduce the incidence of complications and fatality rate in patients with HCH,improve the prognosis,and raise the self-care ability of patients.