高血压脑出血患者立体定向微创颅内血肿清除术的最佳时机分析

发布时间：2018-10-10 17:18

【摘要】：目的探讨高血压脑出血患者颅内血肿清除术的时间窗。方法研究对象为92例行立体定向微创颅内血肿清除术的高血压脑出血患者,根据其脑出血发生至手术时间分为四组:6 h组11例,6~12 h组19例,12~24 h组49例,24 h组13例。统计其术后1个月血肿完全清除率和再出血率,术前及术后1、3、6个月拉斯哥预后评分(GOS)、日常生活能力(ADL)评分、美国国立卫生研究所脑卒中评分量表(NIHSS)评分,术前及术后3天、7天、1个月、3个月颈动脉收缩期峰值流速(PSV)、舒张期末血流速度(EDV)、平均血流速度(Vm)和阻力指数(RI)。结果术后1个月时四组血肿完全清除率、再出血率均逐渐降低,其中6 h组血肿完全清除率高于24 h组,24 h组再出血率低于其他三组(P均0.05)。术后3个月,四组GOS、ADL评分均高于术后1个月,NIHSS评分均低于术后1个月(P均0.05)。6 h组、6~12 h组术后1、3、6个月GOS、ADL评分均高于12~24 h组、24 h组,NIHSS评分低于12~24 h组、24 h组,组间比较P均0.05;6 h组GOS评分均高于6~12 h组(P均0.05)。术后3天、7天、1个月、3个月,四组PSV、EDV、Vm均高于术前,RI均低于术前;术后7天及1、3个月,四组PSV、EDV、Vm均高于术后3天,RI均低于术后3天;各时间点比较P均0.05。6 h组、6~12 h组术后3天、7天、1个月、3个月PSV、EDV、Vm均高于12~24 h组、24 h组,RI均低于12~24 h组、24 h组,组间比较P均0.05。6 h组脑出血复发导致的死亡率为18.2%(2/11)、6~12 h组为15.8%(3/19)、12~24 h组为22.4%(11/49)、24 h组为38.5%(5/13),24 h组高于6 h组、6~12 h组(P均0.05)。结论高血压性脑出血患者最佳手术时间窗为脑出血后6 h内。
[Abstract]:Objective to explore the time window of intracranial hematoma clearance in hypertensive intracerebral hemorrhage patients. Methods 92 patients with hypertensive intracerebral hemorrhage undergoing stereotactic minimally invasive intracerebral hematoma removal were divided into four groups according to the time from the onset of intracerebral hemorrhage to the operation time: 6 h group (n = 11), 6 h group (n = 19), 12h group (n = 49), 24 h group (n = 13). The complete clearance rate and rebleeding rate of hematoma at 1 month after operation, the prognosis scores of (GOS), before and after 1 and 6 months of operation and the (ADL) score of ADL, and the (NIHSS) score of the Stroke scale of the National Institutes of Health of the United States of America were calculated. Peak systolic velocity of carotid artery before and after 3 days, 7 days, 1 month and 3 months after operation: (PSV), end diastolic velocity (EDV), mean velocity (Vm) and resistance index (RI). Results the complete clearance rate and rebleeding rate of hematoma in the four groups decreased gradually at one month after operation. The complete clearance rate of hematoma in the 6 h group was higher than that in the 24 h group, and the rebleeding rate in the 24 h group was lower than that in the other three groups (all P 0.05). At 3 months after operation, the GOS,ADL score of the four groups was higher than that of the first month after operation, and the NIHSS score was lower than that of the 1 month after operation (all P 0.05). The GOS,ADL score in the 6 ~ 12 h group was higher than that in the 12 ~ 24 h group, and the NIHSS score in the 24 h group was lower than that in the 12 ~ 24 h group and 24 h group. The GOS score of 6 h group was higher than that of 6 h group (P 0.05). At 3 days, 7 days, 1 month, 3 months after operation, the PSV,EDV,Vm of the four groups were higher than those before operation, and the RI of the four groups were lower than those of the preoperative ones, the PSV,EDV,Vm of the four groups were higher than that of the 3 days and the RI of the four groups were lower than 3 days after the operation on the 7th day and the 1st and 3rd month after operation. At each time point, P was 0.05.6 h group, 6h 12 h group, 3 days, 7 days, 1 month, 3 months PSV,EDV,Vm were higher than 1224 h group, 24 h group, RI were lower than 12 24 h group, 24 h group. The mortality rate of intracerebral hemorrhage recurrence was 18.2% (2 / 11), 15.8% (3 / 19), 22.4% (11 / 49), 38.5% (513 / 13) in 6h group, 612h group, 38.5% (513 / 49) in 24 h group (P < 0.05). Conclusion the best operative time window for hypertensive intracerebral hemorrhage is within 6 hours after intracerebral hemorrhage.
【作者单位】：哈励逊国际和平医院;
【分类号】：R651.1

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