超早期、早期及晚期治疗高血压基底节区脑出血的临床疗效及安全性对比分析  

Clinical efficacy and safety of ultra early,early and late treatment of hypertensive basal ganglia cerebral hemorrhage

作　　者：王红娟 张媛春 逄凌云 袁海成 刘凤娟 高强 WANG Hongjuan;ZHANG Yuanchun;PANG Lingyun;YUAN Haicheng;LIU Fengjuan;GAO Qiang(Primary Medical Department,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Department of Neuroelectrophysiology,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Out-patient Department,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Department of Neurology,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Clinical Trial Research Center,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Department of Neurosurgery,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China)

机构地区：[1]康复大学青岛中心医院基层医疗科,山东青岛266042 [2]康复大学青岛中心医院神经电生理室,山东青岛266042 [3]康复大学青岛中心医院门诊部,山东青岛266042 [4]康复大学青岛中心医院神经内科,山东青岛266042 [5]康复大学青岛中心医院临床试验研究中心,山东青岛266042 [6]康复大学青岛中心医院神经外科,山东青岛266042

出　　处：《中华神经外科疾病研究杂志》2025年第2期66-71,共6页Chinese Journal of Neurosurgical Disease Research

基　　金：山东省医药卫生科技发展计划项目(202103020759);青岛市卫生科技计划项目(2020-WJZD082)。

摘　　要：目的对比及分析超早期、早期及晚期治疗高血压基底节区脑出血的临床疗效及安全性。方法选择2019年6月到2024年6月期间康复大学青岛中心医院收治的120例高血压基底节区脑出血患者作为研究对象,均行神经内镜微创脑内血肿清除术治疗。按照不同手术治疗时期将其分为超早期组(出血到手术时间<6 h,n=34)、早期组(出血到手术时间6~12 h,n=45)和晚期组(出血到手术时间>12 h,n=41)。对比分析三组患者的临床疗效、生活质量及生活能力[生活质量评价量表(SF-36)评分、日常生活能力量表(ADL)]、血清指标[C反应蛋白(CRP)、B型钠尿肽(BNP)、神经元特异性烯醇化酶(NSE)]、预后情况[格拉斯哥预后评分(GOS)]及并发症。结果早期组总有效率为97.78%,明显高于超早期组的82.35%、晚期组的78.05%(P<0.05)。治疗后,三组患者SF-36、ADL评分均升高,且早期组高于超早期组、晚期组(P均<0.05);三组患者CRP、BNP均降低,且早期组低于超早期组、晚期组;三组患者NSE均升高,且超早期组、晚期组高于早期组(P均<0.05)。早期组患者的预后良好率为95.56%,明显高于超早期组的67.65%、晚期组的65.85%(P<0.05)。早期组患者的并发症总发生率为11.10%,明显低于超早期组的55.88%、晚期组的48.78%(P<0.05)。结论高血压基底节区脑出血患者于出血6~12 h内进行手术治疗的疗效及安全性更好,能够显著改善患者生活质量、生活能力及血清指标水平,并改善患者整体预后。Objective To compare and analyze the clinical efficacy and safety of ultra-early,early and late treatment of hypertensive basal ganglia intracerebral hemorrhage.Methods A total of 120 patients with hypertensive basal ganglia intracerebral hemorrhage admitted to Qingdao Central Hospital,University of Health and Rehabilitation Sciences from June 2019 to June 2024 were selected as the study subjects,and all of them underwent neuroendoscopic minimally invasive intracerebral hematoma removal.According to different surgical treatment periods,the patients were divided into ultra-early group(bleeding to operation time<6 h,n=34),early group(bleeding to operation time 6-12 h,n=45)and late group(bleeding to operation time>12 h,n=41).The clinical efficacy,quality of life and ability to live[SF-36 score,ADL score],serum indexes[C-reactive protein(CRP),B-type natriuretic peptide(BNP),neuron-specific enolase(NSE)]and prognosis[GOS]and complications of the 3 groups were compared and analyzed.Results The total effective rate of the early group was 97.78%,higher than that of the ultra-early group(82.35%)and the late group(78.05%)(P<0.05).After treatment,SF-36 and ADL scores were increased in all three groups,and the early group was higher than the ultra-early group and the late group(P<0.05).After treatment,CRP and BNP were all decreased in the three groups,with the early group lower than the ultra-early group and the late group;the NSE was increased in the three groups,with the ultra-early group and the late group higher than the early group(P<0.05).The good prognosis rate of the early group was 95.56%,which was higher than that of the ultra-early group(67.65%)and the late group(65.85%)(P<0.05).The total incidence of complications in the early group was 11.10%,which was lower than 55.88%in the ultra-early group and 48.78%in the late group(P<0.05).Conclusions Surgical treatment in hypertensive basal ganglia intracerebral hemorrhage within 6~12h has better efficacy and safety,which can significantly improve not only the quality of

关 键 词：高血压基底节区脑出血 手术时机 临床疗效 安全性 

分 类 号：R651.1[医药卫生—外科学]