影响手术治疗高血压脑出血患者预后的因素分析  

Factors related to the prognoses in the patients with hypertensive intracerebral hemorrhage undergoing surgery

作　　者：朱建艇[1] 张捷[1] 杨崇阳[1] 吴勇[1] 王伟[1] 付锴[1] 谢腾[1] 

机构地区：[1]武汉大学中南医院神经外科,430071

出　　处：《中国临床神经外科杂志》2011年第9期530-532,535,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨影响手术治疗高血压脑出血患者预后的因素。方法回顾性分析手术治疗的166例高血压脑出血患者的临床资料。患者被分为脑室外引流组、小骨窗组、骨瓣开颅组,分析其临床特征、术后1个月的治疗结果及影响预后的因素。结果本组死亡48例,总死亡率为28.9%。术前GCS≤7患者的死亡率为38.1%(45/118),GCS>7患者的死亡率为6.2%(3/48)。脑室外引流组、小骨窗组、骨瓣开颅组死亡率分别为35.3%(18/51)、20.3%(14/69)、34.8%(16/46);GOS分别为(27.1±1.6)、(3.3±1.6)和(2.5±1.5)分。相关分析显示,GOS与术前血肿量呈负相关,与术前GCS呈正相关;逐步回归分析显示,术前GCS明显影响GOS。结论术前血肿量及GCS与手术治疗的高血压脑出血患者预后相关;应根据不同的出血量及出血部位选择适当的手术方式。Objective To explore the factors influencing the prognoses in the patients with hypertensive intracerebral hemorrhage（HICH） treated by surgery.Methods The clinical data of 166 patients with hypertensive intracerebral hemorrhage,of whom,46 underwent external ventricular drainage,69 keyhole（small-bone-window） craniotomy and 51 decompressive craniectomy,were analyzed retrospectively.Results The dead rates in the external ventricular drainage,keyhole craniotomy and decompressive craniectomy groups were 35.3%（18/51）,20.3%（14/69） and 34.8%（16/46） respectively.The dead rates in the patients with preoperative GCS ≤ 7 points and one with GCS7 points were 38.1%（45/118） and 6.2%（3/48） respectively.the GOS in the external ventricular drainage,keyhole craniotomy and decompressive craniectomy groups were（27.1±1.6）,（3.3±1.6） and（2.5±1.5） points respectively.The correlation analysis showed that GOS was negatively correlated with the preoperative intracerebral hematoma volume（P 0.01） and positively with preoperative GCS（P 0.01）.The regression analysis showed that GOS was significantly influenced by the preoperative GCS in the patients with hypertensive intracerebral hemorrhage treated by the surgery.Conclusions The preoperative intracerebral hematoma volume and GCS are important factors related to the prognoses in the patients with hyperiteasive intracerebral hemorrhage treated by surgery,in whom,the appropriate surgical method should be selected according to the intracerebral hematoma volume and the bleeding region.

关 键 词：高血压 脑出血 手术 预后 影响因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R544.1[医药卫生—临床医学]