摘要
目的研究并比较手术临界量（出血量为30—50ml）自发性幕上脑出血患者采用手术和保守疗法的有效性。方法回顾性分析2011年8月—2016年9月于延安大学附属医院和宝鸡市中心医院诊断为自发性幕上脑出血420例患者的病例资料，依据治疗方法不同分为手术组和保守组，每组各210例。手术组主要采用开颅大骨瓣减压手术，必要时行脑室外引流；保守组药物治疗主要包括降低颅内压、血压控制、预防并发症及其他个性化治疗。主要观察指标是患者出院6个月后的神经系统功能状态，次要指标是出院后1个月及6个月的病死率和并发症。计量资料以均数±标准差（x±s）表示，组间比较采用两独立样本t检验。计数资料以百分率表示，组间比较采用r检验。结果两组患者治疗6个月后mRS评分及NIHSS评分差异无统计学意义（均P〉0．05），但按中线偏移程度及脑室内有无出血分层分析，中线偏移〉5mm和伴随脑室内出血患者手术组神经功能恢复良好比例分别为18．2％和17．3％，高于对照组8．1％和5．O％（x^2=4．099，P=0．043；x^2=4．836，P=0．028）。手术组1个月和6个月病死率分别为19．0％和23．8％，均显著低于保守组31．0％和36．7％（x^2=7．937，P=0．005；x^2=8．228，P=0．004）。同时手术组肺部感染和需长期带管发病率分别为31．9％和28．6％，均显著高于对照组15．7％和19．5％（x^2=15．173，P=0．000；x^2=4．706，P=0．030）。结论手术与保守治疗相比可显著降低自发性幕上脑出血患者1个月和6个月病死率，改善明显存在中线偏移或脑室内出血患者的神经功能结局。
Objective To study and compare the efficacy of surgery and conservative treatments for patients with critical （30 to 50 ml） spontaneous deep supratentorial intracerebral hemorrhage. Methods The clinical data of 420 patients diagnosed as spontaneous deep supratentorial intracerebral hemorrhage in Affiliated Hospital of Yan＇an and Central Hospital of Baoji from August 2011 to September 2016 in this study were retrospectively analyzed. All patients were divided into surgery group （210 cases） and conservative group （210 cases） according to the difference of treatment methods. Large trauma craniotomy was used by the operation group, external ventricular drainage as the standby in necessary. The treatment of conservative group mainly included reduction of intracranial pressure, blood pressure management, prevention of complications and other individualized treatment. The primary outcome was neurological functional status of patients at 6 months of discharging, and the secondary outcomes included the mortality at 1 month and 6 months of discharging, and complications. Continuous data were presented as x± s and were compared using the t test, while categorical data were presented as number and percentage and were compared using the 2（2 test. Results No obvious difference on mRS score and NIHSS score occurred between two groups （ All P 〉 0.05 ）. Stratified analysis, patients with midline shift 〉 5 mm and with intraventricular hemorrhage were more likely to have a favorable outcome from surgery compared with conservative group （ 18.2% vs. 8.1%, x^2 = 4. 099, P = 0. 043 ; 17.3% vs. 5.0%, x^2 = 4. 836, P = 0. 028）. The mortality at 1 month days and 6 months in surgery group were significantly lower than that in conservative group （ 19.0% vs. 31.0%, x^2 =7. 937, P = 0. 005 ; 23. 8% vs. 36. 7%, x^2 = 8. 228, P = 0. 004）. Meanwhile, the incidence of pulmonary infection and with long-term pipe in surgery group were significantly higher than those in conservative group （31.9% vs. 15.7%,x^2 =15.
作者
韦玮
王小龙
张春满
艾鑫
刘赟
黄元志
朱峰
郑云锋
Wei Wei;Wang Xiaolong;Zhang Chunman;Ai Xin;Liu Yun;Huang Y uanzhi;Zhu Feng;Zheng Yunfeng(Department of Neurosurgery,Affiliated Hospital of Yan＇an University, Yan＇an 716000, China)
出处
《国际外科学杂志》
2018年第6期397-401,共5页
International Journal of Surgery
关键词
脑出血
外科手术
自发性幕上脑出血
治疗结果
保守治疗
Cerebral hemorrhage
Surgical procedures
operative
Spontaneous deep supratentorial intracerebral hemorrhage
Treatment outcome
Conservative treatment
