手术方式和手术时机的选择对不同部位高血压脑出血患者预后影响的临床研究
发布时间：2018-08-10 22:35
【摘要】：目的:探讨手术方式和手术时机的选择对不同部位高血压脑出血患者预后的影响。方法:回顾分析安徽医科大学附属巢湖医院神经外科2006年3月—2013年8月手术治疗高血压脑出血106例患者的临床资料。按发病至手术时间分为3组:超早期组53例为6 h内手术,早期组30例为6~24 h内手术,延期组23例患者为24 h以后手术。依据患者的出血部位采取不同的手术方式,按手术方式分3组:小骨窗显微血肿清除术(小骨窗组)52例,其中基底节区出血35例、皮质下出血11例和小脑出血6例;骨瓣开颅清除血肿术(骨瓣组)34例,其中基底节区出血21例、小脑半球出血13例;侧脑室外引流术(外引流组)20例,其中进展缓慢小脑出血破入脑室8例、丘脑出血破入脑室12例。比较采用3种不同术式和3种不同手术时机的患者术后1个月GOS评分(4~5分为近期疗效优良)、术后6个月ADL分级(Ⅰ~Ⅲ级为远期疗效优良)情况。结果:术后1个月GOS评分结果显示,超早期组近期疗效优良率为81.13%(43/53),高于早期组(50.00%,15/30)与延期组(43.48%,10/23),差异均有统计学意义(P值均0.01);而早期组与延期组间差异无统计学意义(P0.05)。术后6个月ADL分级结果显示,超早期组远期优良率为94.23%(49/52),高于早期组(51.72%,15/29)和延期组(50.00%,11/22),差异均有统计学意义(P值均0.01),而早期组与延期组间差异无统计学意义(P0.05)。小骨窗组、骨瓣组和外引流组3组间术后1个月GOS评分结果显示的近期疗效优良率(分别为71.15%(37/52)、52.94%(18/34)、65.00%(13/20))比较和术后6个月ADL分级结果显示的远期疗效优良率(分别为76.47%(39/51)、68.75%(22/32)、75.00%(15/20))比较,差异均无统计学意义(P值均0.05)。结论:不同部位的高血压性脑出血患者应选择不同的手术方式和合适的手术时机进行个体化治疗,可取得相应的手术疗效。
[Abstract]:Objective: to investigate the influence of surgical methods and timing on the prognosis of patients with hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods: the clinical data of 106 patients with hypertensive intracerebral hemorrhage treated by neurosurgery in Chaohu Hospital affiliated to Anhui Medical University from March 2006 to August 2013 were retrospectively analyzed. According to the time from onset to operation, the patients were divided into three groups: 53 cases were operated within 6 hours in the ultra-early group, 30 cases in the early group were operated within 6h, and 23 cases in the delayed group were operated after 24 hours. According to the location of hemorrhage, the patients were divided into 3 groups: 52 cases of small bone window microhematoma removal (small bone window group), including 35 cases of basal ganglia hemorrhage, 11 cases of subcortical hemorrhage and 6 cases of cerebellar hemorrhage; Craniotomy and removal of hematoma (bone flap group) in 34 cases, including basal ganglia hemorrhage in 21 cases, cerebellar hemispheric hemorrhage in 13 cases, lateral ventricular drainage (external drainage group) in 20 cases, in which slow progressive cerebellar hemorrhage broke into the ventricle in 8 cases. Thalamic hemorrhage broke into the ventricle in 12 cases. The GOS score of 1 month (4 / 5) and the ADL grade of 6 months (鈪，
本文编号：2176421
[Abstract]:Objective: to investigate the influence of surgical methods and timing on the prognosis of patients with hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage). Methods: the clinical data of 106 patients with hypertensive intracerebral hemorrhage treated by neurosurgery in Chaohu Hospital affiliated to Anhui Medical University from March 2006 to August 2013 were retrospectively analyzed. According to the time from onset to operation, the patients were divided into three groups: 53 cases were operated within 6 hours in the ultra-early group, 30 cases in the early group were operated within 6h, and 23 cases in the delayed group were operated after 24 hours. According to the location of hemorrhage, the patients were divided into 3 groups: 52 cases of small bone window microhematoma removal (small bone window group), including 35 cases of basal ganglia hemorrhage, 11 cases of subcortical hemorrhage and 6 cases of cerebellar hemorrhage; Craniotomy and removal of hematoma (bone flap group) in 34 cases, including basal ganglia hemorrhage in 21 cases, cerebellar hemispheric hemorrhage in 13 cases, lateral ventricular drainage (external drainage group) in 20 cases, in which slow progressive cerebellar hemorrhage broke into the ventricle in 8 cases. Thalamic hemorrhage broke into the ventricle in 12 cases. The GOS score of 1 month (4 / 5) and the ADL grade of 6 months (鈪，
本文编号：2176421
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