【摘要】：目的:探討手術(shù)方式和手術(shù)時(shí)機(jī)的選擇對(duì)不同部位高血壓腦出血患者預(yù)后的影響。方法:回顧分析安徽醫(yī)科大學(xué)附屬巢湖醫(yī)院神經(jīng)外科2006年3月—2013年8月手術(shù)治療高血壓腦出血106例患者的臨床資料。按發(fā)病至手術(shù)時(shí)間分為3組:超早期組53例為6 h內(nèi)手術(shù),早期組30例為6~24 h內(nèi)手術(shù),延期組23例患者為24 h以后手術(shù)。依據(jù)患者的出血部位采取不同的手術(shù)方式,按手術(shù)方式分3組:小骨窗顯微血腫清除術(shù)(小骨窗組)52例,其中基底節(jié)區(qū)出血35例、皮質(zhì)下出血11例和小腦出血6例;骨瓣開顱清除血腫術(shù)(骨瓣組)34例,其中基底節(jié)區(qū)出血21例、小腦半球出血13例;側(cè)腦室外引流術(shù)(外引流組)20例,其中進(jìn)展緩慢小腦出血破入腦室8例、丘腦出血破入腦室12例。比較采用3種不同術(shù)式和3種不同手術(shù)時(shí)機(jī)的患者術(shù)后1個(gè)月GOS評(píng)分(4~5分為近期療效優(yōu)良)、術(shù)后6個(gè)月ADL分級(jí)(Ⅰ~Ⅲ級(jí)為遠(yuǎn)期療效優(yōu)良)情況。結(jié)果:術(shù)后1個(gè)月GOS評(píng)分結(jié)果顯示,超早期組近期療效優(yōu)良率為81.13%(43/53),高于早期組(50.00%,15/30)與延期組(43.48%,10/23),差異均有統(tǒng)計(jì)學(xué)意義(P值均0.01);而早期組與延期組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6個(gè)月ADL分級(jí)結(jié)果顯示,超早期組遠(yuǎn)期優(yōu)良率為94.23%(49/52),高于早期組(51.72%,15/29)和延期組(50.00%,11/22),差異均有統(tǒng)計(jì)學(xué)意義(P值均0.01),而早期組與延期組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。小骨窗組、骨瓣組和外引流組3組間術(shù)后1個(gè)月GOS評(píng)分結(jié)果顯示的近期療效優(yōu)良率(分別為71.15%(37/52)、52.94%(18/34)、65.00%(13/20))比較和術(shù)后6個(gè)月ADL分級(jí)結(jié)果顯示的遠(yuǎn)期療效優(yōu)良率(分別為76.47%(39/51)、68.75%(22/32)、75.00%(15/20))比較,差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論:不同部位的高血壓性腦出血患者應(yīng)選擇不同的手術(shù)方式和合適的手術(shù)時(shí)機(jī)進(jìn)行個(gè)體化治療,可取得相應(yīng)的手術(shù)療效。
[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，

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