Glasgow昏迷量表在高血压性脑出血急救策略选择中的作用  

Effect of Glasgow Coma Scale on the choice of treatment strategy in acute hypertensive intracerebral hemorrhage

作　　者：张宁[1] 杨华堂[1] 

机构地区：[1]河北省邯郸市中心医院神经外科,056001

出　　处：《中国现代神经疾病杂志》2017年第3期223-227,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨入院时Glasgow昏迷量表(GCS)评分对高血压性脑出血患者急救策略的影响。方法共286例高血压性脑出血患者中186例接受手术治疗,包括GCS评分5~8分94例、9~11分71例和12~14分21例,分别予血肿清除术联合去骨瓣减压术(63例,22.03%)、单纯血肿清除术(21例,7.34%)和血肿钻孔引流术或脑室外引流术(102例,35.66%);100例接受保守治疗,包括GCS评分5~8分25例、9~11分27例、12~14分25例和15分23例。随访3~6个月,采用Glasgow预后分级(GOS)评价疗效。结果 GCS评分5~8分组失访6例(5.04%),GOS分级1级14例(11.76%)、2级21例(17.65%)、3级39例(32.77%)、4级22例(18.49%)、5级17例(14.29%);GCS评分9~11分组失访2例(2.04%),GOS分级1级6例(6.12%)、2级2例(2.04%)、3级6例(6.12%)、4级48例(48.98%)、5级34例(34.69%);GCS评分12~14组GOS分级4级15例(32.61%)、5级31例(67.39%);GCS评分15分组GOS分级4级1例(4.35%)、5级22例(95.65%),组间差异具有统计学意义(χ~2=142.966,P=0.000)。结论高血压性脑出血患者入院时GCS评分与其预后呈正相关,GCS评分越高、GOS分级越高。Objective To investigate the effect of Glasgow Coma Scale（GCS） on the choice oftreatment strategy in acute hypertensive intracerebral hemorrhage. Methods Among 286 patients withhypertensive intracerebral hemorrhage,186 patients underwent operation. According to GCS scores onadmission,186 cases included 94 cases of GCS 5-8,71 cases of GCS 9-11 and 21 cases of GCS 12-14.These patients respectively underwent hematoma clearance and decompressive craniotomy（N = 63,22.03%）,hematoma clearance（N = 21,7.34%）,trepanation and drainage or external ventricular drainage（N = 102,35.66%）. The rest（N = 100） underwent conservative treatment,including 25 cases of GCS 5-8,27 cases ofGCS 9-11,25 cases of GCS 12-14 and 23 cases of GCS 15. Glasgow Outcome Scale（GOS） was used toevaluate curative effect after 3-6 months follow-up. Results The proportion of GOS in GCS 5-8 groupwas 14 cases（11.76%） of Grade 1,21 cases（17.65%） of Grade 2,39 cases（32.77%） of Grade 3,22 cases（18.49%） of Grade 4 and 17 cases（14.29%） of Grade 5,except 6 lost cases（5.04%）. The proportion ofGOS in GCS 9-11 group was 6 cases（6.12%） of Grade 1,2 cases（2.04%） of Grade 2,6 cases（6.12%） ofGrade 3,48 cases（48.98%） of Grade 4 and 34 cases（34.69%） of Grade 5,except 2 lost cases（2.04%）.The proportion of GOS in GCS 12-14 group was 15 cases（32.61%） of Grade 4 and 31 cases（67.39%） ofGrade 5. The proportion of GOS in GCS 15 group was one case（4.35%） of Grade 4 and 22 cases（95.65%）of Grade 5. Differences between groups had statistical significance（χ^2= 142.966,P = 0.000）.Conclusions The prognosis of patients with hypertensive intracerebral hemorrhage is positively related toGCS score on admission. The higher the GCS score is,the higher the GOS grade will be.

关 键 词：格拉斯哥昏迷量表 颅内出血 高血压性 急救 颅骨切开术 减压术 外科 引流术 

分 类 号：R651.12[医药卫生—外科学] R544.1[医药卫生—临床医学]