高血压脑出血手术治疗时机的选择及对患者预后及生活质量的影响研究

目的探讨高血压脑出血(HCH)手术治疗时机的选择及对患者预后及生活质量的影响。方法84例HCH患者,按手术时机不同分为A组、B组、C组,各28例。A组在发病6 h内行微创穿刺引流术,B组在发病7~24 h内行微创穿刺引流术,C组在发病>24 h行微创穿刺引流术,对比三组的疗效、美国国立卫生研究院卒中量表(NIHSS)评分及格拉斯哥预后量表(GOS)评分变化、并发症发生率及再出血率、生活质量。结果A组治疗总有效率92.86%高于B组及C组的71.43%、64.29%,差异有统计学意义(P<0.05)。术后,A组NIHSS评分(6.25±1.74)分低于B组的(10.68±2.19)分和C组的(10.93±2.32)分,GOS评分(5.54±0.29)分高于B组的(4.72±0.54)分和C组的(4.18±0.39)分,差异有统计学意义(P<0.05)。A组再出血率3.57%低于B组的21.43%与C组的25.00%,差异有统计学意义(P<0.05)。A组并发症发生率10.71%与B组、C组的10.71%、7.14%比较差异无统计学意义(P>0.05)。术后,A组的心理功能评分(79.26±6.87)分、生理功能评分(78.46±5.34)分、社会功能评分(77.59±5.21)分、物质生活评分(54.69±3.35)分、生活质量综合评定问卷-74(QOLI-74)总分(290.00±11.84)分均高于B组的(66.59±6.11)、(68.36±3.58)、(65.01±3.85)、(50.17±3.43)、(250.13±10.92)分与C组的(64.97±5.86)、(64.19±4.35)、(64.31±3.96)、(50.21±3.38)、(243.68±11.05)分,差异有统计学意义(P<0.05)。结论HCH选择在发病6 h内行微创穿刺引流术效果最好,能快速去除血肿,挽救受损神经细胞功能,降低再出血率,改善预后,提高生活质量,具有积极的临床意义。

Study on timing of surgery for hypertensive cerebral hemorrhage and its effect on the prognosis and quality of life of patients

Objective To discuss the timing of surgery for hypertensive cerebral hemorrhage(HCH)and its effect on the prognosis and quality of life of patients.Methods A total of 84 HCH patients were divided into group A,group B and group C by different timing of surgery,with 28 cases in each group.In group A,minimally invasive puncture and drainage was performed within 6 h of onset,in group B,minimally invasive puncture and drainage was performed within 7-24 h of onset,and in group C,minimally invasive puncture and drainage was performed after 24 h of onset.The efficacy,changes of National Institutes of Health stroke scale(NIHSS)score and Glasgow outcome scale(GOS)score,occurrence of complications,rebleeding rate and quality of life were compared among three groups.Results The total effective rate of treatment was 92.86%in group A,which was higher than 71.43%and 64.29%in group B and group C,and their difference was statistically significant(P<0.05).After operation,NIHSS score(6.25±1.74)points in group A was lower than(10.68±2.19)points in group B,and(10.93±2.32)points in group C.GOS score(5.54±0.29)points in group A was higher than(4.72±0.54)points in group B and(4.18±0.39)points in group C.Their difference was statistically significant(P<0.05).The rebleeding rate 3.57%in group A was lower than 21.43%in group B and 25.00%in group C,and their difference was statistically significant(P<0.05).The incidence of complications was 10.71%in group A,and it had no statistically significant difference compared with 10.71%and 7.14%in group B and group C(P>0.05).After operation,psychological function score(79.26±6.87)points,physiological function score(78.46±5.34)points,social function score(77.59±5.21)points,material life score(54.69±3.35)points and generic quality of life inventory-74(QOLI-74)(290.00±11.84)points in group A were higher than(66.59±6.11),(68.36±3.58),(65.01±3.85),(50.17±3.43)and(250.13±10.92)points in group B and(64.97±5.86),(64.19±4.35),(64.31±3.96),(50.21±3.38)and(243.68±11.05)points in group C.Their difference was statistically significant(P<0.05).Conclusion Minimally invasive puncture and drainage shows best effect within 6 h of onset for HCH.It can quickly remove the hematoma,save the damaged nerve cell function,reduce the rebleeding rate,improve the prognosis and improve the quality of life.It contains positive clinical significance.