【摘要】 目的研究早期分步控制性减压手术治疗高血压脑出血(HICH)的疗效及预后不良的影响因素。方法纳入2018-01—2020-02绵阳市中心医院治疗的76例高血压脑出血患者,观察组及对照组各38例,对照组采取常规减压手术治疗,观察组采取早期分步控制性减压手术治疗,比较2组治疗效果、下肢运动功能及预后,并分析其不良预后的影响因素。结果治疗后观察组NIHSS评分低于对照组(t=8.538,P=0.000),2组FAC、FMA均显著升高,且观察组FAC(t=7.298,P=0.000)、FMA(t=23.164,P=0.000)显著高于对照组;观察组预后良好率显著高于对照组(χ~2=4.077,P=0.044);预后不良以及预后良好组年龄(t=5.862,P=0.000)、GCS(t=2.474,P=0.016)、血肿量(t=56.336,P=0.000)、高血压(χ~2=4.631,P=0.032)以及糖尿病(χ~2=7.981,P=0.005)差异有统计学意义,年龄、术中血肿量以及GCS评分较高,同时合并高血压、糖尿病均是造成患者预后不良的独立危险因素。结论对于高血压脑出血患者,将早期分步控制性减压手段应用于去骨瓣减压手术中,对于患者的预后具有积极意义。建议针对年龄、术中血肿量以及GCS评分较高且同时合并高血压、糖尿病患者予以关注,以降低不良预后的发生。更多还原

【Abstract】 Objective To study the effect of early step-by-step controlled decompression in the treatment of hypertensive intracerebral cerebral hemorrhage patients and the influencing factors of poor prognosis.Methods This study mainly adopts the prospective research method,taking 76 cases of hypertensive cerebral hemorrhage patients diagnosed and treated in our hospital from January 2018 to February 2020 as the research object.The control group was treated with conventional decompression surgery,and the observation group was treated with early step-by-step controlled decompression surgery.The treatment effect,lower limb motor function and prognosis of the two groups were compared Influencing factors of poor prognosis.Results After treatment,the NIHSS score of the observation group was lower than that of the control group(t=8.538,P=0.000),the FAC and FMA of the two groups increased significantly,and the FAC(t=7.298,P=0.000) and FMA(t=23.164,P=0.000) of the observation group were significantly higher than those of the control group;the good prognosis rate of the observation group was significantly higher than that of the control group(χ~2=4.077,P=0.044).There were statistically significant differences in age(t=5.862,P=0.000),GCS(t=2.474,P=0.016),hematoma volume(t=56.336,P=0.000),hypertension(χ~2=4.631,P=0.032) and diabetes mellitus(χ~2=7.981,P=0.005) among the patients with good prognosis and poor prognosis.Age,higher intraoperative hematoma volume and GCS score,and patients with hypertension and diabetes are independent risk factors for poor prognosis.Conclusion In the surgical treatment of decompressive craniectomy,the application of early step-by-step controlled decompression in the operation has a positive significance for the prognosis of patients.In the treatment of patients,it is suggested to focus on the age,the amount of hematoma during operation and the higher GCS score,and pay attention to the patients with hypertension and diabetes,so as to reduce the occurrence of adverse prognosis.更多还原