高血压脑出血外科治疗近期预后多因素分析

目的通过比较高血压脑出血手术治疗不同术式的疗效,分析近期预后的主要影响因素。方法对全国92家医院2464例高血压脑出血手术治疗患者进行了多中心临床单盲对照研究。以传统骨瓣开颅血肿清除术（称传统组）作为对照组,以微创手术脑内血肿清除术（称微创组）和CT引导立体定向血肿抽吸术（称碎吸组）作为研究组。对3种术式疗效的影响因素进行多元分析。结果传统手术组有639例,微创手术组有409例,碎吸手术组有1416例。影响微创手术近期预后的因素主要有：术前格拉斯哥昏迷评分（GCS）及术后并发症;影响碎吸组手术近期预后的因素主要有：术前GCS、术前病程、出血量、术后并发症及术中是否使用尿激酶。影响传统手术组近期预后的因素主要有：入院时舒张压、术前GCS、术前肌力及术后并发症。结论脑出血临床预后相关因素及卫生经济学的分析对于今后脑出血的治疗和进一步研究都具有十分重要的意义,它有助于规范手术的适应证;有助于今后临床试验的设计;有助于指导医生的治疗策略,合理的分布医疗资源,更好的为社会群体服务。

Multianalysis of short-term prognostic factors in surgical practices for hypertensive intracerebral hemorrhage

Objective To evaluate and compare the effectiveness of different types of surgicaltherapy for patients with hypertensive cerebral hemorrhage,and analyze the major risk factors of prognosis.Methods 2464 patients with hypertensive cerebral hemorrhage in 92 hospitals in different areas of Chinaunderwent different types of surgical treatment: Group I(n=639),undergoing traditional craniotomy ascontrol;Group II(n=409),receiving minimally invasive hematoma evacuation;and Group III(n=1416),receiving CTguided stereotaxic hematoma aspiration.The clinical data were collected and underwentmultianalysis.Results The factors influencing the short-term prognosis were Glasgow coma scale(GCS)score before surgery and the incidence of postoperative complications in Group II;GCS score before surgeryand the incidence of postoperative complications and volume of hemorrhage,duration between ictus andsurgery,use of urokinase in Group III;and GCS score before surgery,muscle power before surgery,diastolic pressure at admission and postoperative complications in Group III.Conclusion Analysis ofprognosis related factors of cerebral hemorrhage plays a very important role in the selection of therapeuticstrategy.It may be beneficial for standardizing surgical indications,further designing large scale clinicaltrial,helping the doctors select appropriate strategy of treatment,and serving the social population better.