重症高血压脑出血手术治疗时机及预后分析  

The Analyses of Surgical Methods and Occasions for the Patients with Severe Hypertension Cerebral Hemorrhage

作　　者：高晨[1] 周敏慧[1] 刘耀明[1] 贺云飞[1] 马宝平[1] 

机构地区：[1]兰州军区兰州总医院安宁分院神经外科,兰州730070

出　　处：《中国康复》2010年第2期115-117,共3页Chinese Journal of Rehabilitation

摘　　要：目的:探讨治疗重症高血压脑出血患者的手术时机及方式与疗效的关系。方法:回顾性分析140例重症高血压脑出血手术患者,根据发病至手术时间分为超早期(出血<7h)手术66例(A组),早期(出血8～24h)手术40例(B组)及延迟(出血>24h)手术34例(C组);根据出血部位,出血量及血肿是否破入脑室,而选择小骨窗开颅血肿清除术、开颅血肿清除并去骨板减压术或单侧或双侧脑室外引流术等术式。术后平均随访2年,按ADL能力分级法评定患者生存状况。结果:按ADL能力分级法,A组及B组ADL达1～3级比率明显高于C组,死亡率明显低于C组(均P<0.05);A组与B组比较,ADL达3、4级和死亡率差异无统计学意义;B组与C组比较,ADL达5级的比率差异无统计学意义。结论:高血压脑出血患者手术时机、手术方式的选择是手术治疗效果的关键因素。Objective：To explore the relation of surgical methods and occasions for the patients with efficacy of severe hypertension cerebral hemorrhage.Methods：The clinical data of 140 patients with severe hypertension cerebral hemorrhage subject to surgical therapy were analyzed retrospectively.According to the time course of surgery,they were divided into three groups：ultra-early group（receiving the operations within 7 h,66 cases）,early group（receiving the operations within 7 to 24 h,40 cases）and delayed group（receiving the operations after 24 h,34 cases）.In accordance with bleeding site,the amount of bleeding and whether hematoma broke into the ventricle,the small bone window of craniotomy hematoma,craniotomy and hematoma boneless board decompression,unilateral or two-lateral ventricle drainage treatment were chosen.During the average 2-year follow-up,the recovery and activities of daily living（ADL）after the surgery were observed.Results：In accordance with the classification of ADL,patients in ultra-early group and early group showed higher level of class Ⅰ to Ⅲ than those in delayed group（P0.05）.Patients in ultra-early group showed lower level of class Ⅳ and Ⅴ and death rate than those in delayed group（P0.05）.There was no obvious difference between ultra-early group and early group in class Ⅲ,Ⅳ and death rate（P0.05）.There was no obvious difference between early group and defer group in class Ⅴyet.Conclusion：The choice of proper methods and occasions of operation for the patients with severe hypertension cerebral hemorrhage is the critical factors affecting the efficacy.

关 键 词：重症高血压 脑出血 外科治疗 超早期手术 

分 类 号：R651.1[医药卫生—外科学]