高血压脑出血手术时机与术后再出血的关系

目的 探讨高血压脑出血患者手术时机的选择.方法 回顾性分析经开颅手术治疗的高血压脑出血患者96例,按发病至手术时间分为超早期组(发病6 h内手术)、早期组(发病6～24 h手术)和延期组(发病24 h后手术),每组32例.术后72 h内复查CT,以病灶部位出血量超过20 mL为术后再出血,对各组间术后再出血率比较.结果 超早期组9例发生再出血,再出血率为28.13%.早期组4例发生再出血,再出血率为12.5%.延期组3例发生再出血,再出血率为9.38%.超早期组术后再出血率高于早期组和延期组,差异有统计学意义(P<0.05).结论 超早期手术治疗高血压脑出血会增加术后再出血的机会,术中的精细操作和止血,以及术后持续镇静、控制血压,有助于减少术后再出血的发生.

Relationship between surgical timing and recurrent hemorrhage in patients with hypertensive intracerebral hemorrhage

Objective To discuss the choice of surgical timing of patients with hypertensive intracerebral hemorrhage.Methods We retrospectively analyzed 96 patients with hypertensive intracerebral hemorrhage by surgical treatment.According the time interval between pathogenesis and operation,these patients were divided into the ultra-early group（within 6 h surgery）,the early group（within 6-24 h surgery）and the delay group（after 24 h surgery）,every group included 32 patients.CT examination was performed within 72 hours after operation,and incidence of recurrent hemorrhage was compared in three groups.Results The rate of recurrent hemorrhage after operation was 28.13%（9 of 32）in the ultra-early group,12.5%（4 of 32）in the early group and 9.38%（3 of 32） in the delay group.The rates of recurrent hemorrhage of the early group and the delay group were decreased significantly than the ultra-early group（P〈0.05）.Conclusion Ultra-early operation to treat hypertensive intracerebral hemorrhage can increase the chance of recurrent hemorrhage.The delicate operation and hemostasis during operation,keeping sedation and controlling blood pressure in postoperation might help to reduce recurrent hemorrhage.