医学综述
醫學綜述
의학종술
MEDICAL RECAPITULATE
2015年
3期
546-547,548
,共3页
高血压脑出血%小骨窗显微手术%手术时机
高血壓腦齣血%小骨窗顯微手術%手術時機
고혈압뇌출혈%소골창현미수술%수술시궤
Hypertensive intracerbral hemorrhage%Microsurgery through small skull window%The tim-ing of surgery
目的：探讨小骨窗微创手术治疗高血压脑出血（HICH）的手术时机。方法选择2010年2月至2013年2月在固安县人民医院神经外科治疗的 HICH 患者90例，依据随机数字表法分为两组：观察组（45例）于出血后4～6 h应用小骨窗微创手术治疗；对照组（45例）于出血后7～72 h应用小骨窗微创手术治疗，比较两组患者术后并发症，并比较两组存活患者术后1个月格拉斯哥预后评估（ GOS）和术后6个月日常生活能力（ ADL）分级。结果两组患者均成功完成手术，术后并发症发生率比较差异无统计学意义（P＞0．05）；两组患者存活率比较差异无统计学意义（χ2＝0．137，P＝0．711），术后1个月两组患者GOS预后评估，观察组预后优于对照组（Z ＝9．462，P＝0．024）。术后6个月观察组ADL分级情况优于对照组（Z＝8．517，P＝0．036）。结论超早期小骨窗显微手术治疗HICH，能够快速清除血肿、降低颅内压，减轻继发性脑组织损害，远期临床疗效优于早期手术治疗。
目的：探討小骨窗微創手術治療高血壓腦齣血（HICH）的手術時機。方法選擇2010年2月至2013年2月在固安縣人民醫院神經外科治療的 HICH 患者90例，依據隨機數字錶法分為兩組：觀察組（45例）于齣血後4～6 h應用小骨窗微創手術治療；對照組（45例）于齣血後7～72 h應用小骨窗微創手術治療，比較兩組患者術後併髮癥，併比較兩組存活患者術後1箇月格拉斯哥預後評估（ GOS）和術後6箇月日常生活能力（ ADL）分級。結果兩組患者均成功完成手術，術後併髮癥髮生率比較差異無統計學意義（P＞0．05）；兩組患者存活率比較差異無統計學意義（χ2＝0．137，P＝0．711），術後1箇月兩組患者GOS預後評估，觀察組預後優于對照組（Z ＝9．462，P＝0．024）。術後6箇月觀察組ADL分級情況優于對照組（Z＝8．517，P＝0．036）。結論超早期小骨窗顯微手術治療HICH，能夠快速清除血腫、降低顱內壓，減輕繼髮性腦組織損害，遠期臨床療效優于早期手術治療。
목적：탐토소골창미창수술치료고혈압뇌출혈（HICH）적수술시궤。방법선택2010년2월지2013년2월재고안현인민의원신경외과치료적 HICH 환자90례，의거수궤수자표법분위량조：관찰조（45례）우출혈후4～6 h응용소골창미창수술치료；대조조（45례）우출혈후7～72 h응용소골창미창수술치료，비교량조환자술후병발증，병비교량조존활환자술후1개월격랍사가예후평고（ GOS）화술후6개월일상생활능력（ ADL）분급。결과량조환자균성공완성수술，술후병발증발생솔비교차이무통계학의의（P＞0．05）；량조환자존활솔비교차이무통계학의의（χ2＝0．137，P＝0．711），술후1개월량조환자GOS예후평고，관찰조예후우우대조조（Z ＝9．462，P＝0．024）。술후6개월관찰조ADL분급정황우우대조조（Z＝8．517，P＝0．036）。결론초조기소골창현미수술치료HICH，능구쾌속청제혈종、강저로내압，감경계발성뇌조직손해，원기림상료효우우조기수술치료。
Objective To investigate the timing of surgery of minimally invasive surgery through small skull window in treatment of hypertensive intracerbral hemorrhage ( HICH ) .Methods 90 patients with HICH that received surgery in Neurosurgery of People′s Hospital of Guan County from February 2010 to Feb-ruary 2013 were randomly divided into two groups according to random number table method ,45 cases were in each group,the observation group were treated with minimally invasive surgery through small skull window 4-6 h after hemorrhage;The control group were treated with minimally invasive surgery through small skull window 7-72 h after hemorrhage,compared two groups of patients with postoperative complications were com-pared postoperative complications between the two groups , and compared the glasgow ( GOS) prognosis eval-uation of survivals at 1 month and activity of daily living (ADL) classification at 6 month after operation.Re-sults All the patients were successfully completed the operation , the rate of postoperative complications had no significant difference(P>0.05).Compared the survival rate of patients,there had no significant differ-ence (χ2 =0.137,P=0.711),made the GOS prognosis evaluation of patients at 1st month after operation, the prognosis of the observation group was better than that of the control group ,the difference was statistically significant(Z=9.462,P=0.024).The classification of ADL grade of the observation group after 6 months was better than that of the control group,the difference was statistically significant(Z=8.517,P=0.036). Conclusion Microsurgery through small skull window in the treatment of HICH at ultra-early stage can quickly remove the hematoma, reducing intracranial pressure,alleviate secondary brain damage,it has the better curative effect of long-term than that of the early operation .
