6374例高血压脑出血患者临床特点的分析及治疗方法的选择  

Clinical characteristics of 6374 patients with hypertensive intracerebral hemorrhage and theirtreatment choice

作　　者：张荣军[1] 王晓峰[1] 唐宗椿[1] 刘建新[1] 杨术真[1] 彭雅滨[1] 魏毅君[1] 王军[1] 张坤虎[1] 陈勃勃[1] 杨兴奎[1] 罗文颖[1] 

机构地区：[1]解放军第三医院神经外科,宝鸡721004

出　　处：《中华神经医学杂志》2013年第1期57-61,共5页Chinese Journal of Neuromedicine

基　　金：“十二五”国家科技支撑计划项目（2011BA108805）

摘　　要：目的探讨高血压脑出血患者的临床特点及其治疗方法的选择。方法对解放军第三医院神经外科和神经内科自2000年12月至2011年12月收治的6374例高血压脑出血患者的临床资料进行回顾性总结，分析其临床特点及选择的相应外科手术方式，总结出患者个体化的内外科治疗方法。结果6374例高血压脑出血患者中男性3651例（57．28％），女性2723例（42．72％）；发病年龄在50-70岁者最为多见（占52．79％）；出血部位以基底核区（3592例，占56．36％）最为常见；出血量以≤30mL者（3137例，49.21％）较为多见；症状以恶心呕吐（4382例，68．75％）和肢体功能障碍（4293例，67.35％1最为多见；GCS评分以5-8分者（2763例，43．35％）最为多见；每年1-3月及9-12月为高发季节，发病比例分别占30．11％和40．68％。出血量大于30mL的患者中，微创开颅血肿清除组治疗1月、3月后的Barthel指数明显高于其他治疗方法组，差异有统计学意义（P〈0．05）。结论高血压脑出血的发病与性别、年龄、季节等多种因素有关，有效的预防措施和积极控制血压对其至关重要。出血量大于30mL的患者选择适当的手术方法可以提高患者日常生活能力，改善患者预后。Objective To investigate the clinical characteristics of 6374 patients with hypertensive intracerebral hemorrhage and their treatment choice. Methods A retrospective analysis was conducted on the clinical data of 6374 patients with hypertensive intracerebral hemorrhage, admitted to our hospital from December 2000 to December 2011. Their clinical characteristics and appropriate surgical ways were analyzed to summarize the surgical treatment of individual patient. Results Among 6374 patients, 3651 （57.28%） were male while 2723 （42.72%） were female. Patients aged 50-70 years were the most common. Hemorrhage mostly located on basal ganglia site （n=3592, 56.35%）; patients with hemorrhage less than 30 mL （n=3137, 49.21%） were common. Physical dysfunction was noted in 4293 cases （67.35%） and nausea and vomiting in 4382 cases （68.75%）. A large number of patients （n=2763, 43.35%） had 5-8 scores in the GCS. The patients mainly suffered from hypertensive intracerebral hemorrhage from January to March （30.11%） and from September to December （40.68%） each year. By selecting the appropriate surgical approach, patients with hemorrhage greater than 30 mL had higher Barthel index at 1 and 3 months of the onset and their outcomes were improved. Conclusion The incidence of hypertensive intracerebral hemorrhage is related to gender, age, season and other factors; effective preventive measures and positive control of blood pressure are essential, and righttreatment choice after the onset for patients with hemorrhage greater than 30 mL is the key to determine the prognosis.

关 键 词：高血压脑出血 流行病学 临床特点 神经外科手术 

分 类 号：R651.12[医药卫生—外科学]