手术方式与时机的选择对不同部位高血压脑出血患者预后的影响  

The clinical research on the timing of surgery and surgical approach for the patients with different parts of the hypertensive cerebral hemorrhage

作　　者：李克和[1] 黄录茂[1] 雍成明[1] 杨代明[1] 宣家龙[1] 徐兵[1] 

机构地区：[1]安徽医科大学附属巢湖医院神经外科,合肥238000

出　　处：《中华解剖与临床杂志》2015年第3期230-235,共6页Chinese Journal of Anatomy and Clinics

基　　金：安徽省高等学校省级自然科学研究项目（KJ20132111）

摘　　要：目的探讨不同部位高血压脑出血手术方式与时机的选择及其对患者预后的影响。方法回顾分析安徽医科大学附属巢湖医院神经外科2006年3月—2013年8月手术治疗的高血压脑出血106例患者的临床资料。按发病至手术时间分为3组：超早期组53例为≤6h手术，早期组30例为6—24h内手术，延期组23例为〉24h手术。依据患者的出血部位采取不同的手术方式，按手术方式分3组：小骨窗显微血肿清除术（小骨窗组）52例，其中基底节区出血35例、皮质下出血11例和小脑出血6例；骨瓣开颅清除血肿术（骨瓣组）34例，其中基底节区出血21例、小脑半球出血13例；侧脑室外引流术（外引流组）20例，其中慢性脑于出血破入脑室8例、丘脑出血破入脑室12例。比较采用3种不同术式和3种不同手术时机的患者术后1个月格拉斯哥预后评分（GOS）、术后6个月日常生活能力（ADL）分级情况。结果术后1个月GOS评分结果显示，超早期组近期疗效优良率为81．13％（43／53），高于早期组（50．00％，15／30）与延期组（43．48％，10／23），差异均有统计学意义（P值均〈0．01）；而早期组与延期组间差异无统计学意义（P〉0．05）。术后1个月后不同手术时机组各死亡1例。术后6个月ADL分级结果显示，超早期组远期优良率为94．23％（49／52），高于早期组（51．72％，15／29）和延期组（50．00％，11／22），差异均有统计学意义（P值均〈0．01），而早期组与延期组间差异无统计学意义（P〉0．05）。小骨窗组、骨瓣组和外引流组术后1个月GOS评分结果显示近期疗效优良率分别为71．15％（37／52）、52．94％（18／34）、65．00％（13／20），术后6个月ADL分级结果显示远期疗效优良率分别为76．47％（39／51）、68．75％（22／32）、75．00％（15／20），3组问GOS评分、ADL分级比较差异均无统计学意�Objective To investigate the influence of timing of surgery and surgical approach on the patients with hypertensive cerebral hemorrhage at the different sites. Methods The clinical data of 106 hypertensive cerebral hemorrhage patients with surgery in Chaohu Hospital of Anhui Medical University from March 2006 to August 2013 were retrospectively analyzed. According to the time from onset to surgery, these patients were divided into three groups： the ultra-early group（ ≤6 h, n = 53 ） , the early group （6 -24 h, n = 30）, and the delayed group （ 〉 24 h, n = 23 ）. Taking different surgical methods based on the site of bleeding, then according to these surgical approaches, patients were divided into three groups： 52 cases were treated with small bone window hematoma evacuation （ the small bone window group ） , including 35 cases of basal ganglia, 11 cases of subcortical, and 6 cases of cerebellar hemorrhage, 34 eases were treated with trauma craniotomy hematoma removing surgery （the craniectomy group ） , including 21 cases of basal ganglia and 13 cases of cerebellar hemisphere; 20 cases were treated with lateral external drainage （the external drainage group） , including 8 cases of chronic brain stem hemorrhage broken into ventricles and 12 cases of thalamic hemorrhage rupturing into ventricle. The Glassgow outcome scale （GOS） was compared after one month and the activities of daily living （ADL） classification was evaluated after six months for the patients with the three different surgical approaches and three different timing of surgery. Results The results of the surgery after one month showed the recent excellent rate（81.13% , 43/53 ）in the ultra-early group was higher than the early group （ 50.00% , 15/50 ） and delayed group （ 43.48% , 10/23 ）, the difference were statistically significant （ all P values 〈 0.01 ） , while the difference between the early group and the delayed group was no statistically significant （ P 〉 0.05 ）. One month after operatio

关 键 词：颅内出血 高血压性 神经外科手术 手术时机 手术方式 预后 

分 类 号：R651.1[医药卫生—外科学]