脑出血微创血肿抽吸引流治疗的最佳时机探讨  

Optimal time window for minimally invasive aspiration and drainage of the hematoma in patients with intracerebral hemorrhage

作　　者：刘丽军[1] 薛占苍[1] 杨国卿[1] 张秀明[1] 

机构地区：[1]石家庄市第一医院,050011

出　　处：《中国危重病急救医学》2004年第9期544-546,共3页Chinese Critical Care Medicine

基　　金：河北省科技攻关计划项目 (0 3 14 5 483 A)

摘　　要：目的　寻找脑出血微创颅内血肿抽吸引流治疗的最佳时机。方法　 12 6例脑出血患者按手术超早期 (发病 6 h内 ,6 9例 )、早期 (发病 6～ 2 4 h,5 7例 )分成两组 ,采用欧洲卒中量表 ( ESS)、Bartherl指数 ( BI)评价神经功能恢复状况。结果　手术前两组 ESS评分 ,伴发病、既往史评分及两组不同部位 (壳核、丘脑、脑叶 )出血量比较无统计学差异。发病后 1个月 (排除已死亡者 ) ,超早期组 ESS评分 ( 6 4 .76± 7.12 )分和 BI平均值 ( 6 6 .39± 7.2 3)均明显高于早期组〔分别为 ( 5 9.2 1± 8.6 3)分和 6 1.91± 8.31( P均 <0 .0 1)〕;发病后 3个月时超早期组 BI平均值 ( 79.4 6± 13.2 9)也明显高于早期组 ( 72 .32± 11.86 ) ,P<0 .0 1。超早期组比早期组疗效好 ,两组病死率比较无统计学差异。结论　对于有手术适应证的脑出血患者 ,应尽可能在 6Objective To seek the optimal time window for minimally invasive aspiration and drainage of the hematoma in patients with intracerebral hemorrhage. Methods One hundred and twentysix patients with intracerebral hemorrhage were divided into two groups in terms of the operation time window: ultraearly stage group(within 6 hours) and early stage group (624 hours). European stroke scale(ESS) score and Bartherl index(BI) were used to evaluate the improvement of neurological function. Results There were no significant differences between the two groups in ESS score, complications, and past medical history on hospital admission. Also no difference existed in the volume of hematoma in different regions of the brain between the two groups, including putamen thalamus and brain lobes. However, one month after the onset, mean ESS score was 64 76±7 12 and the mean BI was 66 39±7 23 in the ultraearly stage group (nonsurvivors were excluded), whereas in the early stage group, they were 59 21±8 63 and 61 91±8 31 (nonsurvivors were excluded too), respectively (both P <0 01). Three months after the mean BI was 79 46±13 29 in the ultrasuper early stage group and 72 32±11 86 in the early stage group, and the difference in the two groups was significant( P <0 01). Though surgery in the ultraearly stage gave better results than that in early stage, no marked difference in mortality was found between the two groups( P >0 05). Conclusion The aspiration and drainage of the hematoma should be done as early as possible(within 6 hours of the onset) provided that the patients are fit to undergo the surgery.

关 键 词：脑出血 抽吸引流术 微创手术 最佳时机 

分 类 号：R651.1[医药卫生—外科学]