不同时机钻孔血肿清除引流术治疗高血压脑出血的疗效分析

目的通过回顾性分析不同时机钻孔血肿清除引流术治疗高血压脑出血的疗效,探讨最佳手术时机。方法对2005年11月至2013年11月间均采用钻孔血肿清除引流术式的78例高血压脑出血患者资料进行回顾性分析。根据手术时机分为超早期组(7 h以内)、早期组(7~24 h)、延期组(24~72 h),分析比较术后再出血率、病死率、3个月后远期疗效及并发症等。结果超早期组、早期组及延期组三组再出血率分别为33.3%、9.7%及7.7%。超早期组(7 h以内)再出血率高于早期组(7~24 h)及延期组(24~72 h),早期组与延期组再出血率相当。三组病死率分别为10.4%、11.1%及17.2%,三组病死率比较差异无显著性。远期疗效比较,超早期组与早期组的远期临床疗效相当,且均优于延期组。三组行钻孔血肿清除引流术术后无明显不良并发症。结论钻孔血肿清除引流术手术时机选在7~24 h为最佳,既有利于神经功能恢复又降低再出血风险。

nalysis effect of different time on the treatment of hypertensive intracerebral hemorrhage with cranial drilling hematoma evacuation drainage

Objective To explore the optimal operation time by the retrospective analysis effect of different time on the treatment of hyper-tensive intracerebral hemorrhage with cranial drilling hematoma evacuation drainage. Methods 78 patients with hypertensive intracerebral hemor-rhage treated with cranial drilling hematoma evacuation drainage at different time were analyzed retrospectively. According to the operation time,all these patients were divided into ultra early group（ ＆lt; 7 h）,early group（7 ～ 24 h）,delayed group（24 ～ 72 h）. The rates of postoperative re-bleeding,mortality,efficacy of long term 3 months later and complications were recorded,compared between the three groups. Results The rate of postoperative rebleeding of ultra early group,early group and delayed group was 33. 3% ,9. 7% and 7. 7% . Ultra early group（less than 7 h） rebleeding rate is higher than that of the early group（7 ～ 24 h）and delayed group（24 ～ 72 h）. The rebleeding rate of early group and delayed group is similar. The mortality of three groups were 10. 4% ,11. 1% and 17. 2% . The mortality difference between the three groups was not signif-icant. Comparison of long - term efficacy,long - term clinical efficacy of ultra - early group and the quite early group were superior to that of de-layed groups. Three drilling hematoma drainage lines did not show significant adverse complications. Conclusion Operation timing in 7 ～ 24 h is the best. This method is beneficial to the recovery of neural function and reduce the risk of rebleeding.