经额血肿穿刺引流时机对高血压脑出血患者手术效果及再出血率的影响  

Effect of the timing of transfrontal hematoma puncture and drainage on surgical results and rebleeding rate in patients with hypertensive cerebral hemorrhage

作　　者：徐建平 马丽娜 龚邵慧 张永安 黄丹坪 XU Jianping;MA Li'na;GONG Shaohui;ZHANG Yong'an;HUANG Danping(Department of Neurosurgery,Shangrao People's Hospital,Shangrao,Jiangxi,334000,China;Department of Neurology,Shangrao People's Hospital,Shangrao,Jiangxi,334000,China)

机构地区：[1]上饶市人民医院神经外科,江西上饶334000 [2]上饶市人民医院神经内科,江西上饶334000

出　　处：《当代医学》2024年第24期97-101,共5页Contemporary Medicine

摘　　要：目的分析经额血肿穿刺引流时机对高血压脑出血患者手术效果及再出血率的影响。方法回顾性分析2019年4月至2022年4月上饶市人民医院收治的60例高血压脑出血患者的临床资料,依据发病至接受手术的时间分为超早期组(n=22)、早期组(n=28)与延期组(n=10)。所有患者均在全身麻醉下予以体位辅助经额血肿穿刺引流术,超早期组、早期组、延期组分别在发病<6 h、6~24 h、>24 h进行手术。比较3组术后脑水肿体积、再出血率、并发症发生率、病死率及手术前后美国国立卫生研究院卒中量表(National Institute of health stroke scale,NIHSS)评分、血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平。结果术前,早期组脑水肿体积小于超早期组而大于延期组,超早期组大于延期组,差异有统计学意义(P<0.05);术后,3组脑水肿体积均小于术前,且早期组小于超早期组和延期组,超早期组小于延期组,差异有统计学意义(P<0.05);超早期组再出血率、并发症发生率均高于早期组,差异有统计学意义(P<0.05),超早期组与延期组、早期组与延期组再出血率、并发症发生率比较差异无统计学意义;3组病死率比较差异无统计学意义。术前,3组NIHSS评分比较差异无统计学意义;术后4、8周,早期组NIHSS评分均低于超早期组、延期组,超早期组低于延期组,差异有统计学意义(P<0.05)。术后,3组血清BDNF水平均高于术前,NSE水平均低于术前,且早期组血清BDNF水平高于超早期组、延期组,超早期组高于延期组,早期组血清NSE水平低于超早期组、延期组,超早期组低于延期组,差异有统计学意义(P<0.05)。结论选择超早期经额血肿穿刺引流术治疗高血压脑出血可能增加再出血率、并发症发生率,在病情允许的情况下,早期经额血肿穿刺引流术后神经功能恢复较超早期、延期经�Objective To analyze the effect of the timing of transfrontal hematoma puncture and drainage on surgical results and rebleeding rate in patients with hypertensive cerebral hemorrhage.Methods The clinical data of 60 patients with hypertensive cerebral hemorrhage admitted to Shangrao People's Hospital from April 2019 to April 2022 were retrospectively analyzed,and they were divided into the ultra-early group(n=22),early group(n=28)and the delayed group(n=10)according to the time from onset to surgery.All patients underwent postural assisted transfrontal hematoma puncture and drainage under general anesthesia.The ultra-early group,early group and the delayed group underwent surgery at<6 h,6-24 h and>24 h after onset,respectively.Postoperative cerebral edema volume,rebleeding rate,incidence of complications,mortality rate,the National Institutes of health stroke scale(NIHSS)score,serum brain-derived neurotrophic factor(BDNF)and neuron-specific enolase(NSE)were compared among the three groups.Results Before operation,the cerebral edema volume in the early group was smaller than that in the ultra-early group but greater than that in the delayed group,and the ultra-early group was greater than the delayed group,and the differences were statistically significant(P<0.05);after operation,the cerebral edema volume of the three groups were smaller than those before operation,and the early group was smaller than the ultra-early group and the delayed group,the ultra-early group was smaller than the delayed group,and the differences were statistically significant(P<0.05);the rebleeding rate and incidence of complications in the ultra-early group were higher than those in the early group and the delay group,and the differences were statistically significant(P<0.05),there were no statistically significant differences in the rates of rebleeding and complications between the ultra-early group and the deferred group,and between the early group and the deferred group;there was no statistically significant difference in mortality amon

关 键 词：经额血肿穿刺引流 时机 高血压脑出血 手术效果 再出血率 

分 类 号：R65[医药卫生—外科学]