小骨窗开颅手术时机选择对老年高血压基底节区脑出血预后的影响  

Effects of small bone window craniotomy surgery timing on the prognosis of hypertensive basal ganglia hemorrhage in the elderly patients

作　　者：周宇[1] 陈淳[1] 邓发斌[1] 李元斌[1] 郭川[1] 

机构地区：[1]成都市第六人民医院神经外科,四川省成都市610051

出　　处：《实用老年医学》2015年第7期597-599,603,共4页Practical Geriatrics

摘　　要：目的探究老年高血压脑出血患者小骨窗开颅血肿清除术的手术时机与患者预后的关系。方法回顾性分析本院治疗的90例老年高血压基底节区脑出血患者的临床资料,按手术时机分为早期组和超早期组。比较2组患者术前及术后美国国立卫生神经功能缺损评分(NIHSS)分值、Barthel指数、中国卒中量表评分标准(CSS)的变化以及术后并发症的发生率和再住院率。结果 (1)2组患者术后6月CSS分、NIHSS评分均较术前降低,Barthel指数较术前上升;术后6月末,超早期组CSS分、Barthel指数、NIHSS评分重型、中型、轻型与早期组差异显著(P<0.01)。(2)超早期组患者术后肺部感染、胃肠道反应、消化道出血、泌尿系感染、再出血、再住院比例均显著低于早期组(P<0.05)。结论老年高血压基底节区脑出血患者超早期行显微镜下小骨窗开颅血肿清除术,患者术后肢体功能损伤程度大大降低,且日常生活能力显著提升,术后并发症发生率降低。临床上应在超早期行显微镜下小骨窗开颅血肿清除术。Objective To investigate the relationship between the operation timing of small bone window craniotomy evacuation of hematoma and the prognosis in the elderly hypertensive patients with cerebral hemorrhage. Methods The clinical data of 90 cases of senile hypertensive cerebral hemorrhage in basal ganglia receiving small bone window craniotomy surgery were retrospectively analyzed. All patients were divided into early stage group and ultra early group according to the timing of surgery. NIHSS scores, Barthel index, CSS score before and after the operation, the incidence of postoperative complications and the rate of rehospitalization were compared between the two groups. Results The scores of CSS, NIH- SS were decreased, and the Barthel index was increased 6 months after the operation in the two groups than before. Six months after the operation, NIHSS scores, Barthel index, CSS score showed significant differences between two groups （P〈 0.01）. The postoperative rate of lung infection, gastrointestinal reactions, gastrointestinal bleeding, urinary tract infection, rebleeding, rehospitalization ratio in ultra early groups were significantly lower than those of the early group （P〈0. 05）. Conclusions Microscope small bone window craniotomy evacuation of hematoma in ultra early stage could reduce the degree of injury of limb function, and improve the ability of daily life significantly for the elderly hypertensive patients with cerebral hemorrhage, with low incidence rate of postoperative complications.

关 键 词：高血压脑出血 基底节区 小骨窗开颅血肿清除 老年人 

分 类 号：R651.11[医药卫生—外科学]