【摘要】 目的探讨不同手术方式和手术时机治疗高血压脑出血患者的临床疗效。方法回顾性分析2015年1月至2017年12月期间粤北人民医院神经外科收治的182例高血压脑出血患者的临床资料,根据手术方式将患者分为开颅组(开颅血肿清除术,n=100)和穿刺组(穿刺引流术,n=82);按照发病至手术时间将患者分为三组:超早期组(≤7 h,n=68)、早期组(7～24 h,n=62),晚期组(>24 h,n=52)。记录并比较各组患者术前及术后14 d格拉斯哥昏迷评分(GCS),美国国立卫生院神经功能缺损评分(NIHSS),以及术后再出血情况,术后3个月,比较各组患者的格拉斯哥预后评分(GOS)的优良率。结果术后,开颅组与穿刺组患者的GCS评分分别为(10.38±3.18)分、(9.29±2.79)分,NIHSS评分分别为(12.84±3.37)分、(13.29±4.18)分,两组比较差异均无统计学意义(P>0.05);开颅组与穿刺组术后再出血发生率(12.00%和12.20%)及预后优良率(60.00%和52.44%)比较差异也均无统计学意义(P>0.05);超早期组患者术后再出血发生率为20.59%,明显高于早期组的8.06%及晚期组的5.77%,差异均具有统计学意义(P<0.05);术后随访3个月时,超早期组患者与早期组预后优良率分别为61.76%和62.90%,明显高于晚期组的42.31%,差异均具有统计学意义(P<0.05);但是超早期组与早期组比较差异无统计学意义(P>0.05)。结论开颅血肿清除术及穿刺引流术均是治疗高血压脑出血的有效方法,但是早期手术即发病7～24 h内进行手术是较佳的手术时机。更多还原

【Abstract】 Objective To investigate the clinical efficacy of different surgical methods and timing in the treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 182 patients with hypertensive intracerebral hemorrhage, who admitted to Department of Neurosurgery of North Guangdong People’s Hospital from January2015 to December 2017, were retrospectively analyzed. According to different surgical methods, the patients were divided into the craniotomy group(craniotomy evacuation of hematoma, n=100) and puncture group(puncture and drainage, n=82); according to the time from onset to operation, the patients were divided into three groups: ultra-early group(≤7 h, n=68), early group(7-24 h, n=62), late group(>24 h, n=52). The Glasgow Coma Score(GCS), National Institutes of Health Neurological Deficiency Score(NIHSS) before and 14 days after surgery and postoperative rebleeding were recorded and compared. The Glasgow Outcome Score(GOS) was followed up for 3 months. Results After operation, the GCS scores in the craniotomy group and puncture group were 10.38±3.18 and 9.29±2.79, NIHSS scores were12.84±3.37 and 13.29±4.18, respectively. There was no significant difference between the two groups(all P>0.05); there was no significant difference in the incidence of re-bleeding(12.00% vs 12.20%) and the excellent prognosis rate(60.00% vs 52.44%) between the craniotomy group and puncture group(all P>0.05); the incidence of re-bleeding was 20.59% in the ultra-early group, which was significantly higher than 8.06% and 5.77% in the early and late groups(all P<0.05). After 3 months follow-up, the excellent and good rates of prognosis were 61.76% and 62.90% in the ultra-early group and early group respectively, which were significantly higher than 42.31% in the late group(P<0.05), but there was no significant difference between the ultra-early group and early group(P<0.05). Conclusion Craniotomy evacuation of hematoma and puncture and drainage are effective methods to treat hypertensive intracerebral hemorrhage, but early operation within 7-24 hours of onset is a better time for operation.更多还原