不同时机小骨窗手术治疗高血压脑出血的效果及预后对比  

Comparison of effect and prognosis of small bone window surgery at different timings in treating hypertensive intracerebral hemorrhage

作　　者：秦勤 李刚 赵磊 孙杰 伍万里 杜书迪 Qin Qin;Li Gang;Zhao Lei;Sun Jie;Wu Wanli;Du Shudi(Department of Neurosurgery,Guihang Guiyang Hospital,Guiyang 550000,China)

机构地区：[1]贵航贵阳医院神经外科,贵阳550000

出　　处：《中国综合临床》2025年第1期44-49,共6页Clinical Medicine of China

摘　　要：目的探讨不同时机小骨窗手术治疗高血压脑出血(hypertensive in tracer ebrahemorrhage,HICH)的效果及预后对比。方法选取2021年5月至2023年5月贵航贵阳医院神经外科收治的HICH患者的临床资料进行回顾性分析,按照手术时机不同,将患者分为超早组(发病至手术时间<6 h)与早期组(发病至手术时间≥6~<24 h),采用倾向性评分匹配每组各51例。对比两组患者的围术期指标(手术时间、术中出血量、住院时间、血肿清除率)、并发症发生率、术前及手术7 d后神经功能[美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、Barthel指数]、内皮素与血管升压素(arginine vaopressin,AVP)水平、术后1个月临床疗效[格拉斯哥预后评分(glasgow outcome scale,GOS)]、术后1年内再出血率及病死率。计数资料组间比较采用χ^(2)检验,正态分布的计量资料组间比较采用t检验,等级资料组间比较采用秩和检验。结果超早组患者的术中出血量[(186.54±20.15)mL]、住院时间[(14.45±2.04)d]显著低于早期组[(220.10±24.61)mL、(16.79±2.52)d],差异均有统计学意义(t值分别为7.54、5.15;均P<0.001);术后7 d,超早组与早期组患者的NIHSS[(14.55±1.57)分与(16.14±2.13)分]、内皮素[(69.14±6.37)mg/L与(73.48±6.83)mg/L]、AVP[(12.81±2.02)μg/L与(14.35±2.23)μg/L]较治疗前[(32.67±3.81)分与(32.38±3.53)分、(89.67±7.25)mg/L与(88.24±6.38)mg/L、(18.47±2.41)μg/L与(18.04±2.37)μg/L]显著下降,Barthel指数[(72.35±10.14)分与(67.45±9.78)分较治疗前[(49.45±7.41)分与(47.87±7.37)分]显著上升,差异均有统计学意义(t值分别为31.40、28.13、15.19、11.28、12.85、8.10、13.02、11.42,均P<0.001);且超早组患者的NIHSS、内皮素、AVP显著低于早期组,超早组患者的Barthel指数显著高于早期组,差异均有统计学意义(t值分别为4.29、3.32、3.66、2.48;P值分别为<0.001、0.001、<0.001、0.015);术后1个月,超早组患者的GOS分级ObjectiveTo explore and compare the effect and prognosis of small bone window surgery at different timings in the treatment of hypertensive intracerebral hemorrhage(HICH).MethodsUsing a retrospective analysis,HICH patients admitted to department of neurosurgery of Guihang Guiyang Hospital were selected from May 2021 to May 2023.According to the different surgical timings,the patients were divided into ultra-early group(time from onset to surgery<6 h)and early group(onset to surgery time≥6~<24 h).Propensity score was used to match 51 cases in each group.The perioperative indicators(surgical time,intraoperative blood loss,hospital stay,hematoma clearance rate),incidence rates of complications,neurological function(National Institute of Health Stroke Scale(NIHSS),Barthel index),endothelin and arginine vasopressin(AVP)before surgery and after 7 days of surgery,clinical efficacy(Glasgow Outcome Scale(GOS))at 1 month after surgery,rebleeding rate and mortality rate within 1 year after surgery were compared between both groups.Chi-square test was used for between-group comparison of enumeration data,t test was adopted for between-group comparison of measurement data with normal distribution,and non-parametric rank sum test was adopted for comparison of ranked data between groups.ResultsThe intraoperative blood loss and hospital stay in ultra-early group with(186.54±20.15)mL and(14.45±2.04)d were significantly less or shorter than(220.10±24.61)mL and(16.79±2.52)d in early group,the difference was statistically significant(t values were 7.54 and 5.15;both P<0.001).At 7 days after surgery,the NIHSS((14.55±1.57)and(16.14±2.13)points),endothelin((69.14±6.37)and(73.48±6.83)mg/L)and AVP((12.81±2.02)and(14.35±2.23)μg/L)in ultra-early group and early group were significantly lower than before((32.67±3.81)and(32.38±3.53)points,(89.67±7.25)and(88.24±6.38)mg/L,(18.47±2.41)and(18.04±2.37)μg/L)while the Barthel index((72.35±10.14)and(67.45±9.78)points)was significantly higher than before((49.45±7.41)and(47.87±

关 键 词：小骨窗手术 高血压脑出血 手术时机 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]