中国实用神经疾病杂志
中國實用神經疾病雜誌
중국실용신경질병잡지
CHINESE JOURNAL OF PRACTICAL NERVOUS DISEASES
2015年
17期
3-6
,共4页
邱戈%杨志明%胡帮洪%辛毅
邱戈%楊誌明%鬍幫洪%辛毅
구과%양지명%호방홍%신의
高血压脑出血%立体定向手术%预后%影响因素
高血壓腦齣血%立體定嚮手術%預後%影響因素
고혈압뇌출혈%입체정향수술%예후%영향인소
Hypertensive intracerebral hemorrhage%Stereotactic surgery%Prognosis%Affecting factors
目的：探讨立体定向手术治疗高血压脑出血的临床效果及影响预后的因素。方法选取2011‐02—2013‐04于我科诊治的90例高血压脑出血患者为研究对象，按照治疗方式的不同分为传统保守治疗组和立体定向手术治疗组，每组45例。比较治疗后2组患者的出血量变化、临床疗效、日常生活活动（Activity of Daily Living Scale ，ADL）量表评分及细胞免疫学指标的改变，并分析预后影响因素。结果2组患者治疗后1周、2周和4周出血量均明显减少（P＜0.05），立体定向组均显著低于传统组（P＜0.05）；传统组总体有效率44.44％，明显低于立体定向组的77.78％（P ＜0.05）。立体定向组生活自理能力、CD3＋和 CD4＋阳性细胞率改善明显程度均优于传统组（P＜0.05）；但 CD8＋阳性细胞百分率治疗前后并无明显变化（P＞0.05），组间比较亦无明显差异（P＞0.05）。单因素和多因素分析结果显示，高血压病程（β＝0.761， P ＝0.032）、GCS 评分（β＝0.851， P＝0.025）和体重指数（β＝2.59，P＝0.014）为传统组的独立高危影响因素；立体定向组的独立高危因素为 GCS评分（β＝0.799，P＝0.010）和高血压病程（β＝0.616，P＝0.004）。结论相比传统保守治疗，定向手术治疗可明显改善高血压脑出血患者的临床症状，改善预后。
目的：探討立體定嚮手術治療高血壓腦齣血的臨床效果及影響預後的因素。方法選取2011‐02—2013‐04于我科診治的90例高血壓腦齣血患者為研究對象，按照治療方式的不同分為傳統保守治療組和立體定嚮手術治療組，每組45例。比較治療後2組患者的齣血量變化、臨床療效、日常生活活動（Activity of Daily Living Scale ，ADL）量錶評分及細胞免疫學指標的改變，併分析預後影響因素。結果2組患者治療後1週、2週和4週齣血量均明顯減少（P＜0.05），立體定嚮組均顯著低于傳統組（P＜0.05）；傳統組總體有效率44.44％，明顯低于立體定嚮組的77.78％（P ＜0.05）。立體定嚮組生活自理能力、CD3＋和 CD4＋暘性細胞率改善明顯程度均優于傳統組（P＜0.05）；但 CD8＋暘性細胞百分率治療前後併無明顯變化（P＞0.05），組間比較亦無明顯差異（P＞0.05）。單因素和多因素分析結果顯示，高血壓病程（β＝0.761， P ＝0.032）、GCS 評分（β＝0.851， P＝0.025）和體重指數（β＝2.59，P＝0.014）為傳統組的獨立高危影響因素；立體定嚮組的獨立高危因素為 GCS評分（β＝0.799，P＝0.010）和高血壓病程（β＝0.616，P＝0.004）。結論相比傳統保守治療，定嚮手術治療可明顯改善高血壓腦齣血患者的臨床癥狀，改善預後。
목적：탐토입체정향수술치료고혈압뇌출혈적림상효과급영향예후적인소。방법선취2011‐02—2013‐04우아과진치적90례고혈압뇌출혈환자위연구대상，안조치료방식적불동분위전통보수치료조화입체정향수술치료조，매조45례。비교치료후2조환자적출혈량변화、림상료효、일상생활활동（Activity of Daily Living Scale ，ADL）량표평분급세포면역학지표적개변，병분석예후영향인소。결과2조환자치료후1주、2주화4주출혈량균명현감소（P＜0.05），입체정향조균현저저우전통조（P＜0.05）；전통조총체유효솔44.44％，명현저우입체정향조적77.78％（P ＜0.05）。입체정향조생활자리능력、CD3＋화 CD4＋양성세포솔개선명현정도균우우전통조（P＜0.05）；단 CD8＋양성세포백분솔치료전후병무명현변화（P＞0.05），조간비교역무명현차이（P＞0.05）。단인소화다인소분석결과현시，고혈압병정（β＝0.761， P ＝0.032）、GCS 평분（β＝0.851， P＝0.025）화체중지수（β＝2.59，P＝0.014）위전통조적독립고위영향인소；입체정향조적독립고위인소위 GCS평분（β＝0.799，P＝0.010）화고혈압병정（β＝0.616，P＝0.004）。결론상비전통보수치료，정향수술치료가명현개선고혈압뇌출혈환자적림상증상，개선예후。
Objective To investigate the clinical effect and prognostic affecting factors of stereotactic surgery in patients with hypertensive cerebral hemorrhage. Methods 90 cases with hypertensive cerebral hemorrhage were selected as the research objects from February 2011 to April 2013 in our department. They were randomly divided into the routine group receiving con‐ventional surgery and the study group treated by stereotactic surgery ,45 cases in each group. Bleeding volume ,clinical efficacy and activity of daily living (ADL ) scores ,cellular changes in immunological parameters were compared between two groups , and prognostic factors in both groups were analyzed.Results Bleeding was significantly decreased in both routine group and the study group at 1 ,2 and 4 weeks after treatment (P < 0.05) ,and bleeding in the study group only accounted for 49.88% , 37.18% and 23.98 % of the traditional group ,which was significantly lower than that in the routine group (P< 0.05). Over‐all effective rate of routine group was 44.44% ,which was also significantly lower than that of the study group (77.78% ) (P<0.05). In addition ,self‐care ability ,positive cell ratio of CD3 + and CD4 in study group significantly improved compared with the traditional group (P< 0.05) ;but positive cell ratio of CD8 + did little change (P> 0.05) ,and no significant difference was found between two groups (P> 0.05). Univariate and multivariate analysis showed that the hypertension duration (β= 0.761 ,P= 0.032) ,GCS scores (β = 0.851 , P = 0.025) and BMI (β = 2.59 , P = 0.014) were independent risk factors in routine group ;while independent risk factors were GCS scores (β = 0.799 , P = 0.010) and hypertension duration (β = 0.616 , P =0.004) in study group. Conclusion Compared to conventional conservative treatment ,stereotactic surgery can significantly im‐prove clinical symptoms in patients with hypertensive cerebral hemorrhage ,and improve the prognosis of the disease.
