摘要
目的探讨手术治疗高血压基底核区脑出血的预后影响因素。方法回顾性分析165例高血压脑出血病人的临床资料。采取小骨窗微侵袭手术80例,常规开颅手术85例;超早期手术72例,非超早期手术93例。以近期病死率及术后6月ADL分级作为预后判断指标,采用多因素Logistic回归分析可能影响治疗效果的因素,如年龄、入院GCS评分、颅内血肿量、脑室积血程度、是否发生脑疝、手术时机、手术方式。结果单因素分析:小骨窗微侵袭手术组近期病死率(17.0%)与常规手术组(22.4%)差异无统计学意义,小骨窗微侵袭手术组远期恢复良好率(60.0%)显著性高于常规手术组(42.4%);超早期手术组近期病死率(11.1%)显著性低于非超早期手术组(26.9%),远期恢复良好率(63.9%)显著性高于非超早期手术(40.9%)。多因素分析:入院GCS评分、是否发生脑疝及手术时机对近期病死率有显著性影响,是否发生脑疝、手术时机及手术方式对远期恢复效果有显著性影响。结论超早期微侵袭手术方式可能是降低病死率,改善病人预后的适宜手术方案。
Objective To explore the factors influencing prognosis of surgery for hypertensive cerebral hemorrhage of the basal ganglia. Methods Clinical data of 165 patients with hypertensive cerebral hemorrhage were analyzed retrospectively. The minimally invasive surgery through small craniotomy was performed in 80 cases and traditional surgery in 85. Ultra-early surgery was performed in 72 cases and non-ultra-early surgery in 93. The outcome was evaluated by mortality within 1 month and activities of daily living scores 6 months after surgery. The Logistic regression analysis was used to evaluate the potential prognostic factors, such as age, GCS score, volume of intracranial hematoma, and occurrence of cerebroventricular hemorrhage, cerebral hernia, timing and methods of surgery. Results The single factor analysis showed that the mortality of minimally invasive surgery group was 17.0%, while traditional surgery group was 22.4%, and there was no significant difference between them. But the long-term rate of good recovery atter minimally invasive surgery （60.0%） was significantly higher than that of the traditional surgery group （42.4%）. The mortality of ultra-early surgery group was 11.1%, which was significantly lower than that of non- ultra-early surgery group （26.9%）; while the long-term rate of good recovery of ultra-early surgery group （63.9%） was obviously higher than that of the traditional surgery group （40.9%）. The Logistic regression analysis indicated that the GCS grading, occurrence of brain herniation and operative time influenced the mortality, while the operative time, approach of surgery and occurrence of brain herniation influence the long-term prognosis. Conclusion The ultra-early minimally invasive surgery through small craniotomy may be an appropriate surgical approach to decrease the mortality and improve prognosis for hypertensive cerebral hemorrhage.
出处
《中国微侵袭神经外科杂志》
CAS
2007年第12期531-533,共3页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
颅内出血
高血压性
神经外科手术
预后因素
intracranial hemorrhage, hypertensive
neurosurgical procedures
prognosis factors
