CAJ | 학술논문

目的：探讨高血压脑出血外科手术治疗与保守治疗的适应症，并对其疗效及预后进行分析，为其临床治疗提供可参考依据。方法：共纳入60例诊断为高血压脑出血的患者，根据家属要求及病情严重程度分为A、B两组，A组患者35例给予微创血肿清除术治疗，B组患者25例给予内科保守治疗措施，随访14 d观察临床疗效，随访3月对其预后进行分析。结果：入院时行手术治疗患者总体病情重于保守治疗患者；手术与保守治疗后14d NIHSS评分较入院时均有明显改善，差异有统计学意义（P＜0．05）；出血量＞30mL 及发病＞24h 患者手术治疗疗效高于保守治疗，差异有统计学意义（P＜0．05）；出血量≤30mL患者保守治疗疗效高于手术治疗，差异有统计学意义（ P＜0．05）；发病≤24h患者保守治疗疗效与手术治疗相比差异不明显（ P＞0．05）。治疗后7d、14d血清NSE均较治疗前明显下降，且A组下降更明显，差异有统计学意义（ P＜0．05）；治疗后7d血清SF水平较治疗前升高，B组上升较A组更明显，差异有统计学意义（P＜0．05），治疗后14d血清SF水平下降，A组下降较B组更明显，差异有统计学意义（ P＜0．05）。随访3月两组患者生活质量均有明显提高，差异有统计学意义（ P＜0．05）；且A组患者生活质量提高较B组更明显（ P＜0．05）。结论：高血压脑出血的手术治疗的疗效较保守治疗更明显，患者预后效果更好，但需要根据出血量等具体情况选择手术治疗或保守治疗。
목적：탐토고혈압뇌출혈외과수술치료여보수치료적괄응증，병대기료효급예후진행분석，위기림상치료제공가삼고의거。방법：공납입60례진단위고혈압뇌출혈적환자，근거가속요구급병정엄중정도분위A、B량조，A조환자35례급여미창혈종청제술치료，B조환자25례급여내과보수치료조시，수방14 d관찰림상료효，수방3월대기예후진행분석。결과：입원시행수술치료환자총체병정중우보수치료환자；수술여보수치료후14d NIHSS평분교입원시균유명현개선，차이유통계학의의（P＜0．05）；출혈량＞30mL 급발병＞24h 환자수술치료료효고우보수치료，차이유통계학의의（P＜0．05）；출혈량≤30mL환자보수치료료효고우수술치료，차이유통계학의의（ P＜0．05）；발병≤24h환자보수치료료효여수술치료상비차이불명현（ P＞0．05）。치료후7d、14d혈청NSE균교치료전명현하강，차A조하강경명현，차이유통계학의의（ P＜0．05）；치료후7d혈청SF수평교치료전승고，B조상승교A조경명현，차이유통계학의의（P＜0．05），치료후14d혈청SF수평하강，A조하강교B조경명현，차이유통계학의의（ P＜0．05）。수방3월량조환자생활질량균유명현제고，차이유통계학의의（ P＜0．05）；차A조환자생활질량제고교B조경명현（ P＜0．05）。결론：고혈압뇌출혈적수술치료적료효교보수치료경명현，환자예후효과경호，단수요근거출혈량등구체정황선택수술치료혹보수치료。
Objective:To analyze the clinical datas of patients suffered with hypertensive cerebral hemorrhage , to evaluate the efficacy and prognosis of surgical treatment and conservative treatment , to investigate the surgery and conservative treatment indications .Method:60 patients with hypertension cerebral hemorrhage were included .All patients were randomly divided into group A and group B .Group A were given minimally invasive hematoma removal treatment , and group B were given internal medicine conservative treatment .All patients were followed up for 14 days to observe the clinical curative effect , and followed up for 3months to analyze its prognosis . Result: The overall condition of surgery patients were severe than conservative pa -tients.The NIHSS score after surgery and conservative treatment for 14 days were all improved significantly .The difference was statistically significant ( P <0.05) .The curative effect of patients with bleeding was more than 30mL and onset was more than 24 hours for surgery treatment were better than conservative treatment .The difference was statistically significant (P <0.05). The curative effect of patients with bleeding was less than 30mL for conservative treatment were better than surgery treatment . The difference was statistically significant ( P <0.05) .The differences were not obvious onset was less than 24 hours ( P >0. 05).The levels of NSE were significantly decreased 7 days, 14 days after treatment, and more apparent decline in group A.The difference was statistically significant (P <0.05) .The levels of SF were higher 7 days after treatment , and more apparent in-crease in group A.The difference was statistically significant (P <0.05) .The levels of SF were decreased 14 days after treat -ment, and more apparent decline in group A .The difference was statistically significant (P <0.05).Followed up for3 months the quality life in two groups were significantly improved .The difference was statistically significant ( P <0.05) .The quality life in group A were improved more significantly than group B ( P<0.05) .Conclusion:The curative effect in patients with surgi-cal treatment is more obvious than conservative treatment , the prognosis is also better , but need to choose according to the bleeding details .