高血压脑出血患者的手术时机和手术方式的选择

目的 探讨手术时机和手术方式对高血压脑出血患者预后的影响.方法 将本院2005-08-2012-02收治的高血压脑出血患者按发病至手术时间分为2组,出血后24 h内实施手术为早期手术组,出血后24 h外实施手术为延迟手术组,每组25例.所纳入的50例患者按手术方式分为穿刺引流组（22例）和小骨窗开颅手术组（28例）.比较术后各组间格拉斯哥（GCS）评分及1 a后随访时ADL评分分级.结果 早期手术组术后第3天GCS评分显著高于延迟手术组,1 a后随访ADL评分分级Ⅰ～Ⅲ级显著多于延迟手术组（P＜0.05）;术后第3天,穿刺引流组GCS评分显著高于小骨窗开颅手术（P＜0.05）,但2组1 a后随访ADL评分分级无明显差异.结论 尽早对高血压脑出血患者进行手术能有效提高近期疗效和远期预后,穿刺引流术和小骨窗开颅手术对患者的预后无明显影响.

Observation on the timing of surgery and surgical approach for the patients with hypertensive intracerebral hemorrhage

Objective To investigate the influence of timing of surgery and surgical approach on the patients with hyper- tensive intracerehral hemorrhage. Methods Patients with hypertensive intracerebral hemorrhage from August 2005 to Februar- y 2012 were divided into early surgery group（surgery within 24h after the bleeding, 25 cases ）and delayed surgery group（sur- gery after 24h after the bleeding,25 cases）,then the 50 patients were divided into puncture drainage group with 22 cases and small bone window craniotomy group with 28 cases by surgical approach. The Glasgow Coma Scale score （GCS） and ADL score of two groups were compared. Results The GCS of early surgery group at 3rd day after the treatment were higher than delayed surgery group＇s,and the total cases of ADL score grade I ~ I]I in early surgery group were morer than those in delayed surgery group＇s after one year follow-up, all P~0.05. The GCS of puncture drainage group at 3rd day after the treatment were higher than small bone window craniotomy group＇s （P〈0.05）, hut there was no significant difference of ADL score grading be- tween two groups after one year follow-up. Conclusion The early surgery can improve the efficacy and long-term prognosis of hypertensive intracerebral hemorrhage, and there is no significant effect of puncture drainage and small bone window cranioto- my on the prognosis of patients.