高血压脑出血微创手术时间窗的选择研究

Choice of micro - injury operation time in the patients with hypertensive cerebral hemorrhage

目的 探讨高血压脑出血微创手术时机的选择及疗效分析。方法 以2001-10～2003-03我科收治的78例高血压脑出血患者(出血量30～80mL)为研究对象,分为Ⅰ组:超超早期手术组(发病3h内手术),Ⅱ组:超早期手术组(发病5～7h手术),Ⅲ组:早期手术组(发病7～24h手术),每组各26例,均在CT定位下行微创颅内血肿清除术,对比3组间的治疗效果。结果 Ⅰ组死亡8例,7例死于再出血,1例死于肺部感染,死亡率30.8％。Ⅱ组死亡3例,2例死于肺部感染,1例死于MODS,死亡率11.5％。Ⅲ组死亡4例,3例死于肺部感染,1例死于肾功能衰竭,死亡率15.4％。出院病人6个月随访总生活能力(ADU),Ⅰ组ADLI～3级达66.7％,Ⅱ组ADL1～3级达86.9％,Ⅲ组ADL1～3级达54.5％。结论 高血压脑出血后5～7h作为微创手术救治时间窗是较为适宜的选择。

Objective To investigate the operation time and therapeutic effect on patients with severe hypertensive cerebral hemorrhage. Mehods From 2001. 10 to 2003. 03, 78 patients with hypertensive cerebral hemorrhage were studied and divided into 3 groups: the 26 cases accepted surgical treatment within 3 h were assigned in Ⅰ group, and the 26 cases accepted surgical treatment during 5～7 h after cerebral hemorrhage were assigned in Ⅱ group, and the 26 cases accepted micro-injury operation during 7～24 h after cerebral hemorrhage were assigned in Ⅲ group. Results Case-mortality was 30.8% in Ⅰ group, rehemorrhage was the main reason, the rate was 11.5% and 15.4% respectively in Ⅱ and Ⅲ group. All the cases had been closely followed up for six-months, the score of ADL was much higher in Ⅱ group than other groups. Conclusion The best time in patients accepted micro-injury operation was 5～7 h after cerebral hemorrhage.