中等量高血压脑出血微创与药物治疗疗效的比较
发布时间：2018-11-18 13:54
【摘要】：目的:通过对中等量高血压脑出血患者的治疗方法以及手术时期的效果进行分析研究,确定中等量脑出血患者的治疗方法,以及治疗时期。方法:回顾性选取我院2012年至2015年收治的324例中等量高血压脑出血患者,作为研究对象。男198例,女126例。年龄在45岁至65岁之间,平均年龄(56±3.8),将参加研究的所有患者平均分为2组,微创治疗组和药物治疗组。微创组给予软通道微创血肿清除术治疗,药物组给予保守疗法进行常规治疗。在治疗前及治疗后1周,2周,4周分别对两组患者进行GCS昏迷指数评分和NIHSS神经功能评分并且进行分析。术后第4周对两组患者按照日常生活能力分级法(activitiesdaily living,ADL)进行评分,对比两组患者治疗后的并发症情况进行总结。总结微创组患者不同手术时机进行手术后,患者的恢复状况以及并发症情况。总结两组患者的平均住院费用和住院时间,并且进行对比。结果:(1)治疗后1周,两组患者的GCS平均评分无显著性差异(P0.05),但是治疗2周后两组患者的GCS评分具有显著性差异(P0.05)。(2)两组患者在治疗1周后NIHSS神经功能评分存在显著性差异(P0.05)。且随着治疗后恢复的时间增加,两组患者的神经功能评分的统计学差异越大。(3)主要并发症有消化道出血、肺部感染、颅内感染、肾衰竭、心脏衰竭以及治疗后颅内再次出血,微创组并发症总发生率为25.93%,保守组并发症总发生率为22.22%。经过统计学分析后发现,颅内感染发生率微创组明显高于保守组,具有统计学差异(p0.05),但两组患者总的并发症发生率不存在显著性差异(P0.05)。(4)两组患者的恢复情况存在显著性差异(p0.05)。即微创组患者的恢复情况明显优于保守组,死亡率明显低于保守组。(5)其中超早期与早期进行微创血肿清除术治疗,患者恢复率不存在显著性差异(P0.05),而超早期与延期,早期与延期治疗,患者的恢复情况年均存在显著性差异(P0.05)。(6)超早期、早期以及延期治疗并发症发生率均不存在统计学差异(P0.05)。(7)两组患者的总花费,药费以及住院时间均存在统计学差异(p0.05),但是两组患者的治疗费不存在统计学差异(P0.05)。结论:微创治疗的GCS评分明显优于保守治疗。治疗4周后的神经系统评分也明显优于保守治疗。微创治疗的患者康复程度也优于保守治疗的患者。而且从经济学角度来分析,微创治疗也明显强于保守治疗,两者总并发症发生率相当。因此对于中等量高血压脑出血患者应该选择微创血肿清除术进行治疗。
[Abstract]:Objective: to determine the treatment method and treatment period of moderate hypertensive intracerebral hemorrhage by analyzing the treatment method and the effect during the operation period of patients with moderate hypertensive intracerebral hemorrhage. Methods: 324 patients with moderate hypertensive intracerebral hemorrhage from 2012 to 2015 were selected retrospectively. There were 198 males and 126 females. The average age was (56 卤3.8). All the patients in the study were divided into two groups: the minimally invasive treatment group and the drug treatment group. The minimally invasive group was treated with soft channel minimally invasive hematoma removal and the drug group with conservative therapy. GCS coma index and NIHSS neurological function were evaluated before treatment and 1 week, 2 weeks and 4 weeks after treatment. Four weeks after operation, the patients in the two groups were graded according to the activity of Daily living (activitiesdaily living,ADL) method, and the complications after treatment were compared between the two groups. To summarize the recovery and complications of patients in minimally invasive group. The average cost and duration of hospitalization were summarized and compared between the two groups. Results: (1) there was no significant difference in GCS scores between the two groups at 1 week after treatment (P0.05). However, the GCS scores of the two groups were significantly different after 2 weeks of treatment (P0.05). (2). There was a significant difference in the NIHSS neurological function score between the two groups after 1 week of treatment (P0.05). With the increase of recovery time after treatment, the statistical difference of neurological function score between the two groups was greater. (3) the main complications were gastrointestinal hemorrhage, pulmonary infection, intracranial infection, renal failure. The total incidence of complications was 25.93 in the minimally invasive group and 22.222 in the conservative group. The incidence of intracranial infection in the minimally invasive group was significantly higher than that in the conservative group (p0.05). However, there was no significant difference in the incidence of complications between the two groups (P0.05). (4). There was a significant difference in the recovery between the two groups (p0.05). That is, the recovery of the patients in the minimally invasive group was significantly better than that in the conservative group, and the mortality was significantly lower than that in the conservative group. (5) there was no significant difference in the recovery rate between the super early stage and the early stage of minimally invasive hematoma clearance (P0.05). However, there were significant differences in the average annual recovery between the patients with ultra-early and delayed treatment and treatment (P0.05). (6). There was no significant difference in the incidence of complications between the early and delayed treatment groups (P0.05). (7). The total cost, drug cost and hospitalization time of the two groups were significantly different (p0.05), and there was no significant difference in the incidence of complications between the two groups (p0.05). However, there was no statistical difference between the two groups (P0.05). Conclusion: the GCS score of minimally invasive therapy is better than that of conservative treatment. The nervous system score after 4 weeks of treatment was also significantly better than that of conservative treatment. The degree of rehabilitation of minimally invasive treatment was also superior to that of conservative treatment. From an economic point of view, minimally invasive treatment is also significantly stronger than conservative treatment, the total incidence of complications is the same. Therefore, minimally invasive hematoma clearance should be selected for patients with moderate hypertensive intracerebral hemorrhage.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12
本文编号：2340212
[Abstract]:Objective: to determine the treatment method and treatment period of moderate hypertensive intracerebral hemorrhage by analyzing the treatment method and the effect during the operation period of patients with moderate hypertensive intracerebral hemorrhage. Methods: 324 patients with moderate hypertensive intracerebral hemorrhage from 2012 to 2015 were selected retrospectively. There were 198 males and 126 females. The average age was (56 卤3.8). All the patients in the study were divided into two groups: the minimally invasive treatment group and the drug treatment group. The minimally invasive group was treated with soft channel minimally invasive hematoma removal and the drug group with conservative therapy. GCS coma index and NIHSS neurological function were evaluated before treatment and 1 week, 2 weeks and 4 weeks after treatment. Four weeks after operation, the patients in the two groups were graded according to the activity of Daily living (activitiesdaily living,ADL) method, and the complications after treatment were compared between the two groups. To summarize the recovery and complications of patients in minimally invasive group. The average cost and duration of hospitalization were summarized and compared between the two groups. Results: (1) there was no significant difference in GCS scores between the two groups at 1 week after treatment (P0.05). However, the GCS scores of the two groups were significantly different after 2 weeks of treatment (P0.05). (2). There was a significant difference in the NIHSS neurological function score between the two groups after 1 week of treatment (P0.05). With the increase of recovery time after treatment, the statistical difference of neurological function score between the two groups was greater. (3) the main complications were gastrointestinal hemorrhage, pulmonary infection, intracranial infection, renal failure. The total incidence of complications was 25.93 in the minimally invasive group and 22.222 in the conservative group. The incidence of intracranial infection in the minimally invasive group was significantly higher than that in the conservative group (p0.05). However, there was no significant difference in the incidence of complications between the two groups (P0.05). (4). There was a significant difference in the recovery between the two groups (p0.05). That is, the recovery of the patients in the minimally invasive group was significantly better than that in the conservative group, and the mortality was significantly lower than that in the conservative group. (5) there was no significant difference in the recovery rate between the super early stage and the early stage of minimally invasive hematoma clearance (P0.05). However, there were significant differences in the average annual recovery between the patients with ultra-early and delayed treatment and treatment (P0.05). (6). There was no significant difference in the incidence of complications between the early and delayed treatment groups (P0.05). (7). The total cost, drug cost and hospitalization time of the two groups were significantly different (p0.05), and there was no significant difference in the incidence of complications between the two groups (p0.05). However, there was no statistical difference between the two groups (P0.05). Conclusion: the GCS score of minimally invasive therapy is better than that of conservative treatment. The nervous system score after 4 weeks of treatment was also significantly better than that of conservative treatment. The degree of rehabilitation of minimally invasive treatment was also superior to that of conservative treatment. From an economic point of view, minimally invasive treatment is also significantly stronger than conservative treatment, the total incidence of complications is the same. Therefore, minimally invasive hematoma clearance should be selected for patients with moderate hypertensive intracerebral hemorrhage.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12
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